Second Session, 38th Parliament

REPORT OF PROCEEDINGS (HANSARD)

SELECT STANDING COMMITTEE ON

HEALTH

Vancouver

Tuesday, June 20, 2006

Issue No. 10

RALPH SULTAN, MLA, CHAIR

ISSN 1499-4224

SELECT STANDING COMMITTEE ON HEALTH

Vancouver

Tuesday, June 20, 2006 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 Clerk: Craig James Committee Staff: Jonathan Fershau (Committee Research Analyst) Witnesses: Barbara Crocker (Vancouver Coastal Health Authority) Dr. Heather Manson (Vancouver Coastal Health Authority) Dr. Brian O'Connor (Vancouver Coastal Health Authority) Kathy Romses (Vancouver Coastal Health Authority) Kay Wong (Vancouver Coastal Health Authority)

CONTENTS

Select Standing Committee on Health

Tuesday, June 20, 2006

Page Presentations .............................................................................................................................................................................. 147

H. Manson B. O'Connor K. Wong K. Romses B. Crocker

MINUTES

SELECT STANDING COMMITTEE ON HEALTH

Tuesday, June 20, 2006 10 a.m.

Holiday Inn Vancouver Centre Ballroom West, Main Floor, 711 West Broadway, Vancouver

Present: Ralph Sultan, MLA (Chair); David Cubberley, MLA (Deputy Chair); Michael Sather, MLA; Katherine Whittred, MLA; Charlie Wyse, MLA Unavoidably Absent: Katrine Conroy, MLA; Dave S. Hayer, MLA; Daniel Jarvis, MLA; John Nuraney, MLA; Valerie Roddick, MLA 1. The Chair called the Committee to order at 10:14 a.m. 2. Opening statements by the Chair, Ralph Sultan, MLA 3. The following witnesses appeared before the Committee and answered questions: 1) Dr. Heather Manson, Vice President, Health Services Integration 2) Dr. Brian O’Connor, Medical Health Officer, North Shore 3) Barbara Crocker, Community Nutritionist, Vancouver 4) Kathy Romses, Community Nutritionist, North Shore 5) Kay Wong, Community Nutritionist, Richmond 4. The Committee adjourned to the call of the Chair at 12:27 p.m. Ralph Sultan, MLA Craig James Chair Clerk Assistant and

Clerk of Committees

147

TUESDAY, JUNE 20, 2006 The committee met at 10:14 a.m. [R. Sultan in the chair.] R. Sultan (Chair): I would like to call this meeting to order. Good morning. Welcome to the meeting of the Select Standing Committee on Health of the Brit-ish Columbia Legislature. My name is Ralph Sultan, and we will be welcoming today many experts on the assigned topic that we've been given by the British Columbia Legislature to examine the many dimen-sions of the important public policy issue of child-hood obesity. This, in many ways, is the day for the Vancouver Coastal Health Authority to tell us their views on this important public health issue. Shortly I'll turn it over to Dr. Heather Manson who will conduct the meeting this morning. Just to review the terms of reference of the commit-tee: in February the Legislative Assembly asked this committee to be empowered to examine, inquire into and make recommendations with respect to finding effective strategies to change behaviour and encourage children and youth to adopt lifelong health habits that will improve their health and curb the growing rate of obesity, and to achieve the great goal of leading the way in British Columbia among all North Americans in healthy living and physical fitness.

[1015] In order to do that, we're empowered to conduct consultations, engage in special studies and, of course, hear from expert witnesses such as we will do shortly this morning. We can even subpoena witnesses to ap-pear, should they not be willing to do so voluntarily. I don't think that will be necessary this morning. I would also like to remind us all, particularly the wit-nesses, that today's meeting is a public meeting which will be recorded and transcribed by Hansard Services, the very competent staff over on my right. They are busy with their technology, recording every single word that we all say. A copy of that 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, in fact, is being broadcast as we speak, right now. It's available on the committees website, being broadcast around the world so all those people waiting with bated breath in Africa and Asia to hear what we have to say this morn-ing won't be disappointed. Wherever they might be, they can listen to these proceedings in real time. Before I begin, I would just like the members of the committee and other staff to explain who we are, and then I will turn the meeting over to our experts for their contribution. M. Sather: I'm Michael Sather. I'm the MLA for Maple Ridge–Pitt Meadows. I'm an opposition mem-ber, and my critic role is Intergovernmental Relations.

K. Whittred: I'm Katherine Whittred. I'm the MLA for North Vancouver–Lonsdale. My primary responsi-bility in caucus is to be chair of the social development committee. D. Cubberley (Deputy Chair): I'm David Cubber-ley. I'm the MLA for Saanich South, and I'm the oppo-sition Health critic. R. Sultan (Chair): And the Deputy Chair of this committee. I'm Ralph Sultan, the Chair of the committee. I'm the MLA for West Vancouver–Capilano. C. James (Clerk Assistant and Clerk of Committees): I'm Craig James, Clerk Assistant and Clerk of Committees in the Legislative Assembly of British Columbia. I wear two hats: one as table officer, so when you turn the proceedings on and see the floor of the House, we're the people dressed in black robes. My other prime responsi-bility is being responsible for all the various parliamentary committees of the Legislative Assembly. C. Wyse: I'm Charlie Wyse. I'm the MLA for Cari-boo South. I'm the opposition critic for mental health and addictions. R. Sultan (Chair): The meeting today has been or-ganized and is at the invitation of the Vancouver Coastal Health Authority, and we express our thanks to the CEO of Vancouver Coastal, Ida Goodreau, for inviting us and making available key members of her staff this morning. As, I suppose, the largest health authority in the prov-ince — and I believe it is — and also the location of many specialized facilities serving all British Columbi-ans, I think Vancouver Coastal plays a particularly key role in dealing with this important public policy issue. The proceedings this morning will be conducted by Dr. Heather Manson, who's the vice-president of Health Services Integration. She in turn will introduce the various witnesses. I would hope, Dr. Manson, that perhaps there'd be a little bit of time for some questions and answers as well. We have set aside two hours. With the tech-nical delays and parking, we're starting a little bit late. I, as Chair, at least, would not be terribly per-turbed if we run over a little bit past the scheduled noon quitting time, because I think it's very impor-tant that we allocate a full two hours to the people that you've lined up today. I would hate to cut any of them short because of the importance of their tes-timony. So without further ado, I'll turn it over to Dr. Heather Manson. We have found it useful, Dr. Manson, if each of the expert witnesses just gives a one- or two- or three-sentence biography of who they are.

Presentations H. Manson: Okay. Thank you very much, Mr. Sultan and members of the Select Standing Committee.

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We are honoured to present on this extremely impor-tant topic. I'll introduce myself, and then I think we'll actually do what you've just done and have each person present themselves first. Then we'll go through what the flow of the agenda is.

[1020] My name is Dr. Heather Manson, and my role is vice-president of Health Services Integration. My back-ground: I actually have a very strong clinical back-ground. I've practised internal medicine and hematology for many years and then went back and got some addi-tional training in population health — public health. My current role is at the Vancouver Coastal senior executive team, and it's really to enable, to build, to facilitate, to lead in the building of a full continuum of care around the needs of the people we serve, whether those are people with mental health and addictions, the well population or children and youth. I'm here in the context of children and youth — that full population. My role today will be to basically be the host of this on behalf of Vancouver Coastal Health and Ida Goodreau and our board. Maybe just a few more little bits of details before I go on further and introduce the rest of the team and let them talk a little bit about themselves. I wanted to mention that we did kind of put together an agenda so you'd have a rough sense of how much time each pres-entation would take. We have created a little package for you. It has the slides within it, in case you don't want to strain your necks looking over at the slides over by the wall there. I'd like to introduce Dr. Brian O'Connor, Kay Wong, Barbara Crocker and Kathy Romses. Our repre-sentation here is from across our health authority. We've got Brian O'Connor, who is, of course, the medi-cal health officer from the Coastal area over on the North Shore. Kay Wong is from Richmond. Barbara is from Vancouver HSDA, and Kathy, as well, is from Coastal HSDA. The excitement was such within Van-couver Coastal that we wanted to ensure that we had strong representation from all of our geographic areas. Brian, I'll let you introduce yourself, and then we can go on with Kay. B. O'Connor: Thank you very much, Heather. My name is Dr. Brian O'Connor. I am the medical health officer for the North Shore within Vancouver Coastal. I have been so for nearly 20 years now. My main interests at the present time are population health, approach and focus. Within that population health, approach and focus, my main interest is looking at the power of public policy in advancing health promotion and disease prevention strategies. K. Wong: My name is Kay Wong. I'm a community nutritionist out in Richmond. I've been there for over 20 years. Our practice in Richmond is about population health, mainly child and youth. That's the population that we're working with out there.

B. Crocker: My name is Barbara Crocker. I'm a community nutritionist in Vancouver. Just a little bit about my background in terms of working in public health. I trained at UBC in nutrition and dietetics. To complete our training, we need to do a 12-month internship at a major hospital. I interned at Vancouver General Hospital. When I was there, I was overwhelmed with the disease and suffering of the patients and my role in helping people in a diseased state. During that internship I came into the commu-nity and learned about helping people stay well. I real-ized that was my passion — to promote health and work upstream. I was very fortunate to get a job working here in Vancouver with the Vancouver health department. I worked in a pregnancy outreach program. In that pro-gram, I learned a lot about the social suffering that a lot of people deal with. For 13 years I worked as the school nutrition consultant here in Vancouver. I now work in the zero-to-five program in two community health ar-eas. I'm also the chair of the nutrition practice commit-tee for Vancouver. K. Romses: My name is Kathy Romses. I live and work on the North Shore, and I have three children who were born and raised on the North Shore. I'm very passionate about trying to prevent disease and promote wellness. I like to have my fingers in lots of pies, as you'll see when I give my presentation. I also work at the eating disorder clinic. I planned that for Lions Gate, and that does service the whole Coastal area. I have that slant to my work as well. H. Manson: I'd like to just draw your attention to two other items. First of all, you'll notice that there are some posters on the walls. Those are posters that have been developed by our community nutrition-ists and others. We thought that perhaps during your lunch break, if you were interested, you could have a look.

[1025] Also, we've included for you in the package a number of handouts. Some of them relate to the pro-grams we are providing or working in partnership with others to provide. In addition, there's a document called the Early Years Child Health Report that we just released, and a very important document, which is really the cornerstone of our population health strat-egy, called Towards a Population Health Promotion Ap-proach: A Framework and Recommendations for Action. In our presentation today, we've used the frame-work to create the framework for the presentation, so you'll actually see the framework in action — how a health authority works with others in partnership to promote population health. Without any further ado, I'll get on with the rest of our presentation. This is our Vancouver Coastal vision statement. We are committed to supporting healthy lives in healthy communities with our partners through care, education and research. We've had this vision statement for about three and a half years now, and it's been very robust. It

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has stood the test of time. There are some particular comments in here that I would like to bring out. We're committed to supporting healthy lives, so right up front we're saying that health is not merely the absence of disease. We're also saying that we're com-mitting to supporting healthy lives in healthy commu-nities. There's a recognition in this vision statement that health is not achieved by simply the application of our services and programs — that health is achieved in the context of a healthy community. As we work through the various presentations today you'll see that theme recur again and again. If childhood obesity is going to be addressed, the addressing of that needs to occur in the context of a healthy community. We do this. We support healthy lives in healthy communities with our partners. We recognize that we are not the people who provide health. Health is some-thing that occurs in partnership, and we have many community partners, particularly around this issue of childhood obesity, whether they are schools, munici-palities, parks and recreation, businesses or elected officials. We recognize that to address this problem of childhood obesity, we must work in partnership. We do it not only through care, but also through education and research. That is really our vision state-ment. This is the underpinning for our presentation in our meeting with you today. To give you a quick overview of the presentation: first of all, Dr. Brian O'Connor will be speaking about how we are going to apply our population health framework to this problem of childhood obesity. We hope this will be a useful tool for the standing commit-tee as you move forward with your deliberations. Then we'll speak about specific Vancouver Coastal initiatives, and we'll have each of the representatives from the health service delivery areas talk about specific initiatives in their own communities, once again going back to that whole notion that health, particularly an issue like childhood obesity, occurs in the context of a healthy community. Then we'll move back to Dr. Brian O'Connor talking about some of the principles of change, and then move forward with some recommendations. That really sum-marizes how we have put together our presentation from Vancouver Coastal to the select standing committee. Our feeling was that there probably wasn't a need for questions after my presentation, so I would like to turn it over to Dr. Brian O'Connor. Perhaps if you did have a specific question for me at the end, I could speak to that. B. O'Connor: Thank you very much for inviting us here today again. You may have, in the course of your meetings, seen this particular slide that I think has a very telling message for us. That is: it is possible that if we do not do something now, this generation of chil-dren will be the first to have a shorter lifespan than their parents. That has significant implications. The immediacy of dealing with this issue is very important. This would not only have implications in terms of chronic disease prevalence and incidence in

terms of its effect on the health system, but if we start to have declining lifespan, it has effects in all aspects of our community and our daily lives, from the economy, the workforce and everything on down. I think it is really important for us to recognize that we need to take some immediate action to reverse this trend that we have been seeing.

[1030] Dr. Manson has already pointed out to you this document. This document is an important document within Vancouver Coastal Health. I will talk to it for a couple of slides. I think it's important because it focuses on the things that decision-making bodies can do to support this issue — and many other issues, for that matter. The solution or resolution of childhood obesity and many other issues is not going to be accomplished through programs alone. It's not going to be accom-plished through media strategies. These things are just not enough. You cannot change behaviour one person at a time. It's just not cost-effective, and it's just not practical. What we really do need to look at are the systemic supports that only come from the wise, healthy public-policy-making of decision-making bodies. That requires those decision-making bodies to provide leadership, to build the appropriate partnerships, to engage in advocacy where appropriate and to support the healthy policy development. I'll speak to each one of these for a mo-ment on the next slide. We've outlined these strategies within our frame-work document there, and I think you'll find that it'll be an interesting document to take away. This document is a blueprint for all of our staff within Vancouver Coastal Health, but it is particularly, we hope, a blueprint for our senior executives and our board, because it is at that level that these strategies take on particular importance. We're advocating that all of us within Vancouver Coastal Health should assume a leadership role. We should be champions for issues. We should recognize an issue, and we should be willing to take responsibility and be accountable for the resolution of that issue even if we don't control all the levers that can resolve it. The reason for that is the second bullet, which is the partnership development. If you take accountability and responsibility, you can convene the tables of those necessary individuals and groups that can work to-gether with you to try and resolve this issue. A very good example of that, actually, is the government's ActNow strategy. This is not an issue that is solely within the Ministry of Health; this is an issue of the entire government. As I understand it, the deputy min-isters convene a cross-ministry meeting to discuss how they each can contribute to the promotion of ActNow in this province. I think that's just an example of what could and should be done on many issues. The third bullet is advocacy. I know that some-times, politically, that may be a charged word, because I'm sure many of you have been the subject of advo-cacy from time to time. But sometimes political action is necessary, and it need not be strident or in-your-face

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political action or advocacy. It can be promoting your ideas in a thoughtful, rational way and trying to en-gage and encourage an audience for those thoughts and views. Sometimes it's just as simple as being a credible, recognizable person speaking out on an issue and putting your thoughts out there into the commu-nity at large. The last one is probably the most important of all. That is policy development — creating the favourable environments for change. The environment in which people make behavioural choices is very, very impor-tant, so a supportive environment is critical. The healthy public policies that create those environments are probably the most effective and, I will say, cheapest way to improve health. It's those things that change the system, that regulate the environment in which people make choices that aren't costly — like programs. They don't cost millions and millions of dollars. They are really a public policy that takes political will and the stroke of a ballpoint pen to put into place. Indeed, rather than trying, as I said earlier, to change behaviour one person at a time across this province and all the millions that it might take, those supportive public policies with the political will and the ability to enact that policy can have significant impact in terms of a strategy on childhood obesity. I'm finished with my couple of remarks on these slides. I will return later to wrap up, and I'm going to turn it over now to Barbara Crocker.

[1035] B. Crocker: It is absolutely a privilege and an hon-our to be here and to talk about childhood obesity — and childhood obesity prevention, specifically. Thank you so much for this opportunity. I also need to say that the ActNow initiative is very exciting for people who work in public health. We're thrilled with the provincial goals, their public health goals at a large level. It's wonderful to see this new lens of readiness to commit to the health of the population. I would like to start in terms of leadership and looking at promoting healthy lifestyles and creating supportive environments. If we think about public health practice, public health practice is about working upstream. It's before people get sick. If we're focusing on children who are healthy, encouraging them to stay healthy right from birth…. We have prenatal supports to ensure that that baby is born at a healthy birth weight and is launched into life at a healthy place, and then the supports for that child and the family and the community to promote health. In terms of healthy lifestyles, what we want to do, very first up, is look at breastfeeding support. This is so important because breast milk is a living fluid. It is the best nutrition. It's the gold standard of feeding babies. All of the supports that happen right across the health authority in our infant, child and youth programs sup-port women to breastfeed their babies and to launch those babies really well. To give you an example, I have moms phoning me, who stop breastfeeding. They have family pressure to

stop. They're going back to work. They're stopping early. Why are they stopping? They don't have the supports, the knowledge and so on. I think we do well with early supports around breastfeeding, but there's more to do with breastfeeding supports. It's a very im-portant launch for that baby early in life. If we move on, and adding to that, if we think about healthy eating education and supports for chil-dren from zero to five, here babies have never had solid food. They're learning for the first time about foods to eat. How do parents struggle with that when they don't know how to cook? They don't know what to feed their child. Last week I had a mom come in to see me whose two-year-old was still eating pureed foods. She was coming in to see me because she was worried that her child was eating pureed, jarred baby food at two, and she couldn't get her child to eat regular food. What was happening in the family were issues around eating sweets and treats and candies from the grandma and the dad. I said: "Can we do some counselling with the whole family to look beyond this? This child is at risk for child-hood obesity, given the lens of moving off of purees and on to candies and sweets." So it's a really interesting ex-ample of what's going on for some young families. Breastfeeding support is really important, and then all of the education that we provide for the zero-to-five years. This is the time to actually create those healthy habits, learn to crunch carrots, to bite an apple and to eat chewy, crunchy things, which is very different from eating french fries that are mushy and salty and fatty. It creates a mouth feel, and you create those healthy be-haviours for the types of foods that a child would eat. Now, how we do that in terms of supporting peo-ple…. We do develop a number of fact sheets. In your package you have a couple of examples. One is on healthy snacks for children. This one is for 18 months to five years. What are appropriate snacks? Are they the sweets and candies that the child last week was being exposed to at two, or is it healthier choices? How do we support parents? Through our various programs, com-munity groups, parent support groups where we are able to provide them with health information. Also, there's one on hunger and satiety regulation. What does hunger and satiety regulation have to do with prevention of childhood obesity? I have parents force-feeding their children. They're worried that their child isn't eating enough. They don't know about natu-ral hunger and satiety cues. They have the grandpar-ents chasing the child trying to overfeed them. They want big, fat babies and overfed children. So how do we help them around hunger and satiety cues? This is an example on feeding babies, on hunger and satiety cues. Feeding toddlers. We even have a message in here on: how do you set limits when that toddler wants candies and sweets? How do you set limits and say no and feel okay about that as a parent? These are some really important early messages. This is an example on feeding toddlers — the transition from nine months to 18 months.

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Another one is the art of feeding. We can tell what to feed, but how do you feed a child? It's just as impor-tant as what you feed them. We've developed a num-ber of videos to help parents and to communicate those messages — and print material, as well, that's also translated. We have a lot of families coming from other countries that don't actually read English or speak Eng-lish. So we've translated materials. We have videos that have been translated, as well, to communicate some of those messages.

[1040] Another one in the way of print materials is on television. Again, we think about those early years. What is happening to our children? It's one thing to feed nutritious foods and to have information about that and about how to parent around food and setting limits around food. Another is screen time. Screen time is huge. TV is the babysitter. How do we educate parents around the power of TV and screen time and what that means around physical activity? Also, the type of television advertising on children's programming — it's all about junk food. It's promoting poor-quality food. I did a group a few weeks ago. It was a Somalian women's group. We actually did a supermarket tour. We talked about appropriate beverages, breakfast cereals, breads and so on, and the women said to me: "Well, Barbara, we eat these nutritious choices, but the children want junk cereals and poor-quality drinks." These children were from six to 12 years. They've already been programmed by TV and all of the stuff that the big food corporations are doing, and parents don't know. So we need to help them with media literacy around issues of television and being sedentary, promoting a sedentary lifestyle and the wrong-quality food. Moving on from breastfeeding, healthy eating and education supports in those early years. This is hope-fully launching children with healthy lifestyles, healthy food choices, physical activity and recreation into the school years. If we think about school-based initiatives — and you'll hear about a number of them in a few minutes — the school years are a wonderful opportu-nity. We've got a captive audience of all these children. Is that environment supportive of children? Food security is our final bullet here. Food security is a very important broad brush. Food security is important in terms of access to a safe, nutritious, culturally appropriate, accessible food supply that is available in a dignified manner and that is environmentally sustainable. There are a lot of issues around our local food supply: supporting local agriculture, having grocery stores available, people having adequate income to buy appropriate foods. Maybe that's all I'll say there. Interesting in terms of the link with obesity. In a document that I have here, 50 percent of low-income women were reported as having difficulty putting nu-tritious food on the table; 50 percent of those women were obese — overweight — versus 34 percent who were overweight and food-secure and had difficulty putting nutritious food on the table in their homes.

Another study — this is a Canadian study — looked at the 6.8 percent of children in the wealthiest quartile who were obese versus 12.8 percent of children in the poorest quartile who were obese. If we think about access to nutritious food, what are some of the key ingredients in nutritious food that are markers for growth versus getting calories that don't necessarily promote growth but excess weight? In terms of partnership, this is how we operate in community health. We work in partnership with com-munity groups, with the NGOs — people like the Heart and Stroke Foundation, the Cancer Society, the Vancouver Food Bank and so on — and all of those partnerships with schools. We've got a lot of very keen people in schools to work with us. Parks and rec, local community centres, research…. We have opportunities for evaluation and to study and work with our aca-demics on issues — and of course, our municipalities. We work with the city of Vancouver on child care poli-cies, on issues of food access within communities. All of these partnerships, you'll see in the examples as we move forward, are really critical to how we work in community health. We do not do it in isolation. In terms of advocacy, in the area of education there are a number of reports. In your package there is a highlight of the Cost of Eating report. This is the out-come of a food-costing survey that we've been doing for five years now. I'll just pull it out for you to see — The Cost of Eating in B.C. This is from 2004. It really pro-files the issue of access to adequate income so that people can purchase adequate food. When you're on limited income or income assistance, our food dollars get taken up with other expenses, so people then don't have the food dollars to buy the groceries. We've been doing this for about five years as a pro-vincial network of community nutritionists to raise awareness of the importance of access to adequate in-come to sustain people so they can buy food. We have the food banks that started in 1980. Here we are in 2006, 26 years later. Child hunger is real, and people are using food banks to feed children. So we're really looking at the issue of access to adequate income for feeding children and families.

[1045] Another important advocacy document is Making the Connection. It's a food security and public health document that was developed by community nutri-tionists, again, for decision-makers, to help understand the power of food and nutrition in the health…. Child-hood obesity is like the canary in the coalmine. It is the high marker before we get all of the other diseases — diabetes, heart disease, renal failure, etc. This was meant to help educate people about the power of food and nutrition in terms of health. Healthy choices. We've got a provincial guideline on food and beverage sales in B.C. for schools. This was just launched in the fall and has been an excellent tool to support schools and a tool for community nutri-tionists to work with schools. Vancouver Food Bank. Again, we've set up baby-food tables. In reality, children are being fed through

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food in food banks. Do they have appropriate infant formulas? What types of foods are available? So we've worked with them. Building capacity — working with the parent advi-sory committees, which are the PACs, to help create local champions with parents in local schools. Moving on to policy. With a number of years of food security work in Vancouver, the various local groups and people working together have been able to launch a Vancouver Food Policy Council with the city of Vancouver. It was launched in 2004. There's an ac-tual coordinator within the city of Vancouver around food policy. They're working on a number of initiatives within the Food Policy Council — a food charter. We've developed a growth-monitoring manual, and this is really important if we actually want to in-tervene early with children that might be having weight issues in the preschool years. When are we screening? When do our community health nurses weigh and measure children? How do we support families? So this is a tool and a standard manual for our community health nurses on weighing and meas-uring infants and young children and looking at growth monitoring of children. Finally, Vancouver Coastal vending machine policy — I actually read our draft last night; it's moving forward — to really look at as a role model within our organization for vending and small kiosks. What is the quality of the foods that we have available in that setting? We'll just stop here for questions. H. Manson: Mr. Sultan, I wanted to give an opportu-nity for the select standing committee to ask any questions of Dr. O'Connor or Barbara, particularly around this whole population framework that we've got with leader-ship, advocacy, partnership and policy development. R. Sultan (Chair): Yes, I'm sure we have several questions. K. Whittred: Thank you, Heather and Barbara. Very, very informative. It's really good to get a presen-tation that's sort of: "Right, this is what we're doing on the ground. This is how it works." I have two questions. One of the things that we've heard several times from different presenters is that people don't know how to cook. I find this a bit amaz-ing, but I also know that it is true. We've heard a lot of discussion recently about the need to bring back com-pulsory phys ed. What about bringing back compul-sory home ec? I mean, I really hate to date myself, but in my day, every single woman…. I must say it was very sexist. Girls got home ec; boys got shop. That per-haps needs to be changed, but every single person did get home ec and learned the basis of cooking — the basic, standard methods — nutrition, etc. I wondered if you ever discussed that in any of your discussions. B. Crocker: In terms of looking at a high school level or that grade eight level, they do actually have a course now — and maybe it's changed since I've

worked with the schools — where all of the students would have access to some nutrition and some food skill and food prep. But labelling it as home ec doesn't work. We need to look at sports nutrition. We need to look at chef training. We need to go to a totally new way of operating around how we teach children and youth around food and nutrition, and it could be fantastic. There may be some models that I'm not aware of. Certainly in England they've done a huge piece of work around foods in the schools. I think there's a huge opportunity for us to do things differently, but not call-ing it home ec. K. Whittred: I wasn't meaning necessarily calling it home ec. You can call it anything, but the basic…. B. Crocker: Yeah, but it does need to be re-marketed. It's how we market those messages. Kids love cooking, and you'll see some of the programs that we've launched at the elementary level. Kids love it, but it's how we pack-age it, and that does need some attention.

[1050] K. Whittred: Thank you. My second question really had to do with your last comment around growth monitoring. This is another thing that we've heard — that there isn't a lot of data. I'm just wondering if you can tell us exactly what kind of data your community health nurses do keep and how that manifests itself over the lifetime of a child. B. Crocker: In terms of the growth-monitoring manual, this is very new. It came out in September. I actually just did a training with some of my staff to look at how we monitor children in the early years. Babies are monitored; we actually monitor the growth for a newborn and in those early months. Then it's about who comes into our clinics and when they're screened. If they're having their babies immunized through Public Health, we'd actually be monitoring their growth within Public Health, or the family physi-cians are monitoring growth in those clinics or family doctors' offices. We maybe don't see that. In terms of collation of that and looking at trends, we aren't actually doing that. It's more on an individual teaching basis that that tool is used, and then as a screen for any concerns in terms of growth. M. Sather: I want to second what Katherine said around cooking. I'm not so sure about young people today, but I expect it's about the same as when I grew up. A lot of males, in particular, don't have those skills. I think about the number of separated families now. Oftentimes the children are with their father, and it would be good if he had some cooking skills so that he's preparing nutritious and adequate meals for the kids. I really encourage any of those kinds of programs in schools, to teach those skills. I had a question around intergovernmental rela-tions and the issue of food security. It comes up in

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various forms and through a number of presentations that we've had, such as having local agriculture, as you made mention of, and the availability of that. Well, as you probably know, in the lower mainland in particu-lar there's a tremendous amount of pressure on our agricultural lands for development. I'm wondering: does Vancouver Coastal have any discussions with the Ministry of Agriculture, for example, about food secu-rity and about the necessity of supporting agriculture in its many dimensions? B. Crocker: At the Community Nutritionists Council last fall, actually, we had one of the agrologists attend our provincial nutritionists meeting to present his lens of work around agriculture and the food supply, and we'd absolutely be in partnership with them. In terms of mov-ing it to Vancouver Coastal, I would move it over to the Vancouver Food Policy Council. Certainly we have agri-culture folks involved in that, and various sectors are involved in the Vancouver Food Policy Council. Within Vancouver Coastal Health, though, we don't have a strategic alliance with agriculture. Yet I think we're all very aware of the importance of having local agriculture, partnering with agriculture, supporting buy-local campaigns. We've done all that sort of thing historically. You'll see it on some of our fact sheets; we actually say: "Buy local." There'll be some little tag line there, "Choose foods that are grown in B.C. first," so that we can support our economy and our food system. It is very much interrelated. C. Wyse: Thank you for the presentation. Would you mind elaborating a little further on your method of targeting groups that would be more susceptible? If I was able to follow you correctly, you mentioned issues around the poor and quickly tried to work through single parents, ethnic groups and so on. Would you mind elaborating more specifically on how you go after those groups that show those tendencies toward obe-sity, including in the area of children? B. Crocker: Absolutely. I can think of a great exam-ple. Last week I did a parent group. Actually, I did two groups last Thursday. I had 45 women at a parent-infant drop-in at one of our community centres that's run by our community health nurses. My talk was all about the introduction of solids, hunger, satiety cues, etc. That's where parents will come up to me after-wards and ask individual questions. In the afternoon I did a group that's run through our Healthiest Babies Possible program. All of these women are Spanish-speaking, coming from Mexico and Central America. Within the community there are various cultural supports. We have a program called Building Blocks, which reaches out to various cultural groups to support women with young children or families with young children.

[1055] Within that, they target Vietnamese-speaking, Chinese-speaking, Spanish-speaking…. There's a num-ber of different programs and different agencies that

run programs. First nations groups. A few weeks ago I did a group of parents within the first nations com-munity. Those groups exist, and that's part of our part-nership and how we provide access to information, working with cultural brokers and with the liaisons of those various groups. D. Cubberley (Deputy Chair): Dr. O'Connor, you mentioned in your short presentation the importance of policy interventions as a cost-effective way of doing things. Barbara Crocker was talking about that with a little bit of reference to school food policy guidelines and other things. I may have missed it, but I didn't hear any specific interventions around what's showing up in schools, in particular some of the toxic — from the point of view of obesity — drinks and foods that are readily available in schools. I wondered if you wanted to comment. Does Coastal Health have a policy? Are you urging schools to drop the pop? How are you dealing with that? B. O'Connor: That's to come. We still have three more presentations. You're going to hear all about the initiatives in schools. I tried to stay fairly high level and focus on the early years, because the next three presen-tations will focus on a lot of the school initiatives. R. Sultan (Chair): That's a good introduction to our next presentation. We'll turn it back over to Dr. Manson. H. Manson: And I will turn it over to Kathy. Kathy, come right up, and we'll just move right on. K. Romses: That was an interesting comment, be-cause that was the topic of a press release just sent out that said: "North Vancouver school district drops the pop." I am in the fortunate position of working in part-nership with the North Vancouver school district, which co-funds my position, and I've got a renewal for next year. The previous year I worked with the West Van school district. As I said, I live and work on the North Shore and have children on the North Shore, so I'm very passionate about this. I want to congratulate the government of British Columbia on showing a leader-ship role in providing the food and beverage guide-lines for schools. That has been a huge advocacy tool for me in my position. What happens at the schools is that you quite often have two camps of parents or two camps of teachers who are saying, "We make money on chips and pop," and then another camp that says: "We need to support our children and learning and our health of the future." The B.C. government, by providing the guidelines, has shown a leadership role. Now they can say: "Look. This is a provincial initiative, and we have to fall in line with what the government is saying." So thank you very much for showing a leadership role. We are the first school district in the province to fully comply with the guidelines for food and beverage

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sales in B.C. schools. I was involved in the request for proposal that went out to companies, and I have to say I was a little bit nervous. I thought: I don't know how many choices we can have in these vending machines that meet the guidelines. One of the other side effects or positive effects of something that the B.C. government has done is your school fruit and vegetable project. We now have small packages of fresh B.C. fruit that can be sold in vending machines — apples, pears. We've got carrots with dip, peppers, phenomenal B.C.-grown products. I've also heard that the kiwi farmers on the Island were going to plow under their fields because they could not compete with the products that were coming, let's say, from China. That has been another positive side effect. We've been able to promote B.C. products. We've got products now that we can sell in the vending machines. If you go into the vending machines in the schools right now, I agree that it is toxic. One of the govern-ment guidelines is to have more fruits and vegetables. Go to a vending machine in schools and find out how many fruit and vegetable products you can have, and it's pretty well nonexistent. I want to thank the gov-ernment, again, for showing the leadership and having some of those positive effects that have resulted. I do work with a multidisciplinary team. I am the community nutritionist, but we have dental health, tobacco and mental health. We have the community health nurses, who are really the front-line people.

[1100] I'm in charge of 76 schools on the North Shore. It's not possible for me to really liaise with all of those schools, so I rely on the community health nurses who work with a family of schools to do a lot of my advo-cacy work. These are some of the activities that I've been in-volved with in the North Vancouver school district. There was a community forum. We are actually intro-ducing a school health promotion policy at the school board meeting this evening. There have been big changes to the school cafeteria. We were also in the news in November on the North Shore when the pro-vincial guidelines were launched. We've taken a step to offer healthier choices in the cafeteria as well. I've actually sat and watched the students buy the foods, and now there's quite a change. Burgers are one of the lowest-selling items. Now there are meal pack-ages that come with milk and some sort of salad. Pastas and rice are quite popular. When my daughter came home and said, "You know, there are too many vegeta-bles in the rice at school," I went, "Yes," because she's not a big fan of vegetables, and we're incorporating them into products that the youth like. I am also a big believer in presenting to the parent advisory councils, because they are the same volun-teers who are out in the community at the sports con-cessions as well. I have a monthly Health Matters newsletter that goes out to the schools, which covers a variety of top-ics. You will have a copy of one that I did in January, and you will see my lens of the eating disorder there. I

think that if we focus too much on childhood obesity, we have parents who are very concerned when normal changes happen. When children are ready to really grow up, in their adolescent years, quite often they do put on weight. If we have parents that panic because they think, "Oh my gosh, here goes my child," I think it's really important that we give them the tools. This was a newsletter that went out, and 94 percent of the schools that were sur-veyed actually used the newsletter. I do nutrition education workshops, as well, for teach-ers because, again, they are the leaders. When I talk to them, they're going to present to their students year after year, so it's a very cost-effective way of working. We do something called the Eat Well, Play Well Olympics on the North Shore. We started that three years ago. We had 4,400 elementary school students involved. I'm a big believer in tying in with the family, because it's one thing to say to the students, "You need to offer healthier choices," but it's usually the parents who are buying those foods. The Health Matters newsletter con-nects with families. The Eat Well, Play Well Olympics also has a newsletter that goes out to families, and the students take an active role. The winner this year was Eastview Elementary School in North Vancouver, and the students played a big role. They made announcements every day during the week. The students got points for bringing fruits or vegetables or milk products to school and a point for a half-hour of activity after school. It created a lot of fun and excitement. I had parents giving me feedback, saying: "My children are actually taking over making their lunch, and they're asking for fruits and vegetables so that they can get points at school." It created some fun and a positive way of get-ting that message out. I have the Energize Me! pamphlet that I created. We've handed out, I think, 8,000 copies of this to schools. This is a simplified version of the B.C. food and beverage guidelines. It lists the foods into the four categories: choose most, choose sometimes, choose least and not recommended. If you'll notice, this is similar to another handout that I developed called Energizing Snack Choices. Families will put this up on their fridges. The ones that are not recommended are on the back, so all of the foods that you want the students to be having are on the front of the brochure. I've spoken to about a thousand athletes on the North Shore, and the really positive effect — this has quite often been as a volunteer parent, because I have three active children — is that I'm working with youth. This is the why: why is it important for you to choose healthier food choices? Because you want to give them the winning edge. You want to give them the tips for eating for peak performance.

[1105] The really gratifying side effect of this is that the kids are changing their behaviour. When I pick them up after school, where they haven't had much time, they've made a fruit smoothy, and they're in the car, and we're off to hockey practice. So it's actually chang-

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ing the behaviour, and they are becoming advocates for change. Youth listen to youth, so this has been very popular. Then this is just a sport concession guideline. Again, it's even more simplified — one page on how to offer healthier choices. When I go to the tournament concession stands and have to spend my little two-hour stint as a parent, it drives me crazy when I have to be handing out pop and chips. They used to get a cou-pon, and you'd get a hot dog, chips and a pop. Things are starting to change as a result. Brian O'Connor and I worked together. We sent out concussion guidelines, because as a parent I would watch the kids get a concussion, and they'd be put right back on the rink or out on the playing field. We worked together, sent out a newsletter to schools and to all of the youth organizations on the North Shore, the sport organizations, and some B.C. groups. As a result, some of them have put it on their websites. The B.C. Injury Prevention Unit that sent informa-tion to Brian O'Connor on concussions was used, and they put the sports concession guidelines and the Eating for Peak Performance on their CDs that were handed out at a convention in March. Again, it's those partnerships. We also have a fabulous network on the North Shore called the Active North Shore network. It's promoting individual and community health and wellness. We have multiple partners. They include both of the school districts, both of the recreation commissions, Heart and Stroke Foundation, Canadian Cancer Society, North Shore Credit Union, Action Schools, North Shore News, Park Royal shopping centre and Internet consulting. There's the website. I've actually seen a change in the culture of those organizations. What happens is that we all work to-gether. When I spoke about the Eat Well, Play Well Olympics, the West and North Vancouver recreation centres provided a one-month fitness membership to participating schools to be used as a draw prize, as well as certificates for individual students to go and be ac-tive at the local recreation centre. You do have a "Play And Be Active Game Card!" that was the North Van Recreation Commission. The community health nurses and myself had input into all of the aspects of health — for mind and activity and healthy eating. It's really a cultural shift, and the West Van community services used to have a barbecue with the standard pop, chips. They've changed it. The kids get a card, and they actually track. At the barbecue they are modelling what they want the kids to do. There are healthier choices. Another fantastic thing is that Park Royal — which, again, is one of the partners — is where a lot of youth hang out. We've got a healthy eats program that was just launched at Park Royal recently, and they've got quite a few vendors now who offer a lot healthier choices. They have got nutrition facts information for some of the healthier products. Then Action Schools and North Van school district partner together. They have this fabulous program where they have high school students going into ele-

mentary schools using the Action Schools to get kids more active. Those kids, again, mentored the younger kids in the elementary schools. The older students got credit for their portfolio requirements. It's those part-nerships that are fabulous to see. This is the example of the "play and be active" part. It's: eat well; play well; stay active. Those messages are being used by all of our partners. The Edible Garden Project on the North Shore is a fantastic project with goals to utilize local land to pro-duce food; increase access to fruits and vegetables, par-ticularly in populations that have barriers to access; increase knowledge and skills in food preservation; and increase community ability to respond to the high demand for locally grown produce. It is funded by ActNow, a B.C. community initiative. There are even more partners than are listed on this slide. It's both the city and district of North Vancouver, the district of West Vancouver, North Shore Neighbour-hood House, some of the community garden groups, and the Queen Mary School community garden. That's a high-risk group. They work with North Shore Harvest. They work with Salvation Army.

[1110] I think there are going to be a lot of positive spinoffs, not just in terms of providing food. Katherine Whittred and Michael Sather were mentioning that the skills of cooking…. They're actually including that. The food preservation is part of this project. I think it also develops a sense of community, so people who have extra garden space are partnered with people who are interested in growing more local produce. Also, for those who have a garden and want to grow an extra row, it's then donated to the Salvation Army. Again, it's creating that sense of community and developing partnerships and more fruit and vegetables. As Barbara mentioned, it's also very important to focus on the early years, when habits are developed. On the North Shore there was a Healthy Start for Life resource kit that's on display on the side here. We had workshops in the fall. It was funded by the Ministry of Children and Family Development for parents and early childhood educators that work in day care cen-tres and so on. It's learning more about nutrition and physical activity needs of preschoolers. It was based on the Healthy Start for Life that Dieti-tians of Canada developed, and it uses resources that were developed both in the United States and in Can-ada. Rather than reinventing the wheel, some of those best practices have been put together in a resource kit. It's housed at the North Shore Child Care resource cen-tre on the North Shore, and there are going to be more workshops in the fall. This is another campaign that was in Fit Fest in Bella Coola. It was a two-month campaign to motivate and challenge people to work toward a healthier and more active body, mind and spirit. The thing I really liked about this particular project is that it had two coordinators. There's a large aboriginal community in Bella Coola, and one of the coordinators was from the Nuxalk community.

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It ran from mid-February to mid-April, and there was lots of excitement and fun. We want to create a positive feeling in the community and with students about being active. It's fun to be active, and it's fun to eat healthy foods. You'll see some of the things that come out as far as aboriginal…. They had a sweat lodge. Basketball is big with the aboriginal youth up in Bella Coola. They had toddler Olympics, and brought out 200 parents, in-fants, toddlers and preschools. This is a fairly small community, so I was very impressed by what they were able to do up there. This is another project in the Sunshine Coast–Powell River–Sea to Sky area, called Dodge Diabetes. It was Health Canada funding for preventing type 2 dia-betes. The goal was to promote active living and healthy eating for children, youth and families. They had some phenomenal things that went on throughout this whole area. They had advocates in education workshops, a media campaign. There were freeing tools and brochures. I've got the Pump Up Your Health book that was done for grade four, and a poster. The thing that I really liked…. I was actually filling in on the Sea to Sky area for this dietitian who was on leave. They had mini-grants, so $500 grants went out to the community for a project that's focused on active liv-ing and healthy eating. Some of those have continued. When I was in there — I was at Squamish — they had the recreation centre, and all these partners from the community and all these families and youth came to learn aboriginal dances, to have healthy foods, to learn about early childhood education. Those partnerships that were established by these small mini-grants have continued. Any questions? M. Sather: Kathy, an issue came up in our commu-nity of Maple Ridge this week vis-à-vis the school dis-trict, which put out a letter-to-parents document. In there was an advertisement for Wendy's — no disre-spect, Mr. Chair, to one of our legislative colleagues.

[1115] What is your thought? Obviously, school districts talk about this issue, whether it be vending machines or an ad like this. It's extra revenue that they say they need. What are your thoughts, as you deal with school districts a lot, on how that can be dealt with, what sort of strategies they can use — anything that you can throw into the mix that might be an idea of how that ongoing problem could be dealt with? K. Romses: Okay. I am going to put a condition on this. I'm going to say that this is my personal viewpoint and that this has been developed because I was in my daughter's classroom doing nutrition education as a volunteer parent. Doing a three-day food record with the kids, I thought: "Oh my gosh. My kids are right. They are bringing pop and chips and chocolate bars, and they aren't meeting the minimum number of milk products and fruits and vegetables." I've really changed my viewpoint. Adults, who are really modelling for our kids, are low in milk products

and fruits and vegetables, and children are as well. I used to think, you know, every once in a while it's okay to have Wendy's and so on, but school is a learning environment. We are teaching our kids how to be healthy, productive citizens. I have really changed my focus now, and I am really quite against getting money, to raise funds, to buy whatever — computers or even athletic equip-ment. I've said as a parent when I looked at the money we could get from companies — revenue for vending or revenue from Wendy's: "It's less than the cost of a cup of coffee per month that they're getting in revenue. To me, they're creating these lifelong consumers of their products. I personally feel that in schools it is not the best thing to be doing." I really feel that we're investing in the future of our children when we look at the big picture and think: "You know what? We're in trouble. That canary is sing-ing." We have to recognize that school is a learning environment. C. Wyse: Kathy, I was a little surprised when all of a sudden you took me up to Bella Coola, which is getting very close to where my riding is, and the Sunshine Coast, with targeted groups again. I had asked earlier: with the diversity, how do you get targeted so that the education gets out right throughout all of the different communities? The more educated and having wealth…. That's very enabling. The other parts of the communities that don't have maybe even either of those — how do you make sure that information gets into those groups? K. Romses: I agree. What we try to do is to reach everyone. When we're working with schools, it's a fan-tastic avenue, because you're reaching all of those communities. So that is working with both those who have and those who don't. I think it's really important to try to focus on initia-tives that reach those communities that really need help. In the Dodge Diabetes project, one of the things that happened — again, tying into that food prepara-tion — was that the aboriginal community in Sechelt, which unfortunately I've forgotten the name of, got some money and they started a Kids in the Kitchen project. The young children were taught how to pre-pare the food. Also, they have food delivered to the community, and sometimes they have no idea what to do with the food in that box of food they get. With that Kids in the Kitchen project, they actually taught the community, who also was involved — the elders and the young children — how to use those foods. So there are some targeted interventions, and that is one of the things that Vancouver Coastal Health is trying to do. We're trying to look at everyone and move everyone along the continuum, but we are trying to focus on those high-risk people.

[1120] Another thing that I do…. We've got a fairly new addictions treatment for youth on the North Shore. I have worked with that group to say that when you're working with these youth and moving them into more

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positive behaviours, make sure that you're also offering them healthy food choices. That's my plan for the summer now that school has stopped. I want to go in and work more with them and give them those food skills, because those are very high-risk youth who are just on the edge of homelessness or are homeless. They need those skills that quite often they don't have. C. Wyse: Thank you. If I may, Chair, a couple of follow-up questions with the programs in Bella Coola and the Sunshine Coast. If I follow you correctly, these were some target funds that came in — some startup funds. Are those programs still active and ongoing in Bella Coola? K. Romses: Bella Coola is actually going to be an annual event. It was a public health nurse promotion or education fund that provided…. I spoke to the dietitian up there, and she is saying that this is going to be an annual event. Because it was so successful, it's going to continue on. The same with the things on the Sunshine Coast. Those Dodge Diabetes projects — a lot of those are continuing. They created community partnerships, and they were able to see how successful they were. A lot of those projects are continuing. C. Wyse: Thank you. More than likely you already told me this, but I missed it. When was the activity in Bella Coola? K. Romses: It was mid-February till mid-April. C. Wyse: You did tell me. Thanks for reminding me. K. Romses: You're welcome. K. Whittred: Thank you, Kathy. It's always a pleasure to see how well-resourced we are in North Vancouver. I wanted to ask you a little bit about targeted schools. I'm thinking there about what your approach would be, for example, in working with Queen Mary or Norgate as opposed to Cleveland or Sherwood Park or some of the other schools. K. Romses: For those schools I would actually spend more time. I haven't been able to that much this year. Margaret Broughton also works on the North Shore, and she has been working with the Edible Garden Project, so Queen Mary is one of those schools that is involved. I've actually gone and spoken to the parent advi-sory council at Norgate, but those are schools that do need more support. I've told the school board, as well, that if…. I can't actually go into individual classrooms because I'm in charge of 76 schools and, whatever mul-tiplied, how many classrooms. But with those schools, I will go in because those are high-risk schools. H. Manson: I'll introduce Kay Wong, who's a community nutritionist in Richmond, which is actually where I live. Richmond is a very different community.

It's got a different geography. It's got a different kind of demographic, so you're going to hear a different ap-proach now from Kay. K. Wong: What Kathy was saying is we always work as a team. In Richmond it's the same. The team of people when I'm talking about all these programs in-cludes community health nurses, physicians, dental hygienists, psychiatrists, psychologists, mental health workers, speech, audiologists, so I'm not talking in terms of just nutrition. It involves all these other people that have been working in all these programs. It truly is about partnerships, because we can't do all this work by ourselves. When we have true partner-ships, our partners will take on…. Truly, this is our problem. This is not, you know, yours or yours, but it's ours. We often do something about it. I'm chatting about some of these initiatives and examples of what's going on in Richmond. I just want to make sure that gets across, basically. The first one that I have up here is the school board. The school board has actually put through just now, in the last June meeting…. They're looking at promoting a healthy school policy, and the trustees actually ac-cepted that. Through this next year the schools are all going to be basically looking at a vision statement for their own school about what it means to have a healthy school and supporting kids in a learning environment. So that's going to be happening, and they're going to be doing a lot more work in terms of looking at tools that will help schools do that.

[1125] The other part of that is the Action Schools B.C., which is actually happening in Richmond and all over the province as well. At last count, I think, about 90 percent of all the elementary schools were signed up. They're all registered. I think Richmond was actually involved in the first pilot projects, and so now every-body is coming on board. All that stuff is working to-gether. It's all falling into place. That leadership is really what's important. It enables the schools to say, "Yeah, we need to do this," and "This is truly what we're here for — for the kids." We want to make sure that we enable them to learn, and we want to keep these environments really healthy for all our kids. That's something that's going on all over the province, and in Richmond that's what is happening. In Richmond we're still doing healthy-schools grants. We have about $5,000, and we invite kids and schools to make applications so that they can have a little bit of seed money to make their schools healthier, basically. This last year we had about 14 applications, and ten of them were either nutrition or physical activ-ity in nature. It actually comes from the kids, and a lot of it was: "What can we do at lunchtime and at recess time to stay healthy and active?" So it was those sorts of pro-grams. We had other groups in one of the high schools looking at hungry kids and how we help our friends, our neighbours to make sure that nobody is hungry in their schools.

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We have a real mix of programs and some mixing in terms of a high school and elementary schools and some of that stuff that was going on as well. That truly is a partnership with the school board and ourselves. We've done this for the last five years. We've done it over and over, and it's worked pretty well. Edible school gardens is very much like what Kathy was talking about. This partnership is with the city because they offered us the land. We have all this land out there with the fruit tree sharing project and our Food Security Committee. At this point they're really trying to get the kiddies to start some gardens out at the community gardens but also at their own schools as well. So that's getting going. We've mainly got a lot of elementary schools doing this, as well as one of the high schools. I couldn't get a picture of their tomato garden, but I hear they've got a patch of lots of tomatoes. That's just getting started. We're working with different individual schools. They're at different places. Some are moving straight ahead, and others are getting there. This is happening because of the ActNow fund and the guidelines. I think the guidelines were the push that people needed, and so that was very helpful. Along with that, we've also got the food security funding. That delves into the Good Food Grub and the Colts programs. Those programs are for youth. In our community centres we have a program called the Night Shift, and once a month the kids have a cooking session where they do their own cooking and have a meal together. It's really popular. Part of it is skill-building. When you talked about home ec classes, this is the skill-building on the kids' terms, at their time and with their kinds of foods. They're learning how to prepare some of the foods. The Colts program is based in schools. Again, it's skill-building, and it's young parents. We talked about getting that grocery bag, "What am I going to do with this stuff? This squash — what am I supposed to do with it? This kale?" and not knowing what to do with it. So this is part of the skill-building that we're starting there. The travelling road show and the vending machine are just one of the projects that the nurses have been doing and that we worked together to develop. It goes into the schools, and it's a partnership with the schools, with the parks and rec. The vending machine itself is just a replica of a vending machine, and the kids get to choose one of the snacks. What comes out is a cartridge telling you if it's a healthy or a not-so-healthy choice. The kids just crowd around this machine, and what really worked well is that we had the kids operating it. The learning that goes on is just wonderful. It's just great. The last item I have there is supporting baby-friendly initiatives. I know that Vancouver Coastal Health is talking about…. We're doing our planning right now to do it for the whole region, to make it a baby-friendly environment so that breastfeeding is the norm.

[1130] In Richmond we have a smaller community com-mittee with all kinds of players — La Leche, the hospi-tals there, Richmond health department. We've got our moms on that as well, trying to increase the awareness in the community and make breastfeeding the norm. You're going to see more and more about that. Espe-cially, we've talked about it in terms of our social determinants of health and how it relates to all of that. This is "Got to Move! Eat Good Food!" This is our bookmark contest that we did. We've done it for a cou-ple of years. Last year it was "Feed the Body, Feed the Mind." We did nutrition and literacy. This year it's ac-tivity and nutrition. These are just the three first-place winners that we had. I was only able to find…. All of them are gone, but I've got you one. This is what I have. I've got all the PDF files, if people are really interested, and we can print more. It's basically staying active and eating more fruits and vegetables. The school board was our partner, and parks and rec in Richmond, the public library and Rich-mond Children First. We had over 1,800 entries. At the last school board meeting they honoured all the winners. The little kids got their plaques, and it was wonderful. Energize with 5. This is the sheet we've put into your packages. It came out of our partnership with the book-marks and working with our parks and recreation de-partment. It is, basically, to get kids to eat more fruits and vegetables and to stay active during the summer. We did a lot of planning with parks and rec. Over the summer they have all these summer programs for elementary kids. Part of what they're going to do is model to the kids about what it means to have health-ier snacks. They will only serve healthy snacks in all their programs. At the same time, we're working with parks and rec to look at their vending machines, and using the guidelines as well. You can see that it's morphing over to everywhere, and people are using them. They're really very helpful. This is going to happen over the summer. I think people love the colours for the different vegetables. We would go through it and think: I don't know what that is. People start looking for this. We get lots of questions, even from our own staff as well. The pot of gold is the activity, and kids get to colour that. Questions? R. Sultan (Chair): Questions about Richmond, panel-lists? D. Cubberley (Deputy Chair): I would be kind of interested for you to draw out just a little further the difference between Richmond and the approach there and the other communities we've heard about. K. Wong: The approach is still population health. We truly do believe in working with partners to do the work. Our community was a farming community, but it's not anymore. We have very small pockets of farm-land. A few months ago it came up, and people were

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talking about that, especially the lands. It's still a con-cern in our community. One-third of our population — their first language is not English. We look at our programming, and we look at the partners we have. We just make sure that we have those partners to help us in terms of our pro-gramming. For example, SUCCESS is one of our part-ners in a lot of these programs. They weren't here on my slides, but they are. R. Sultan (Chair): If the Chair may be allowed a question. You have a high ESL population in Richmond. Is it your observation that people come to Canada from other countries and learn all of our bad North American habits and that diet goes downhill from there? K. Wong: You said it. R. Sultan (Chair): Or is it the other way around? They come with bad habits, and we have to improve them.

[1135] K. Wong: I think a little bit of both happens. For new immigrants, everybody wants to fit in. Look at our ads, our media. What's our favourite drink? Is it milk? Is it water? It's pop. You've basically learned that if you want to fit in, you need to drink these fluids. We need to change our environment, basically, to make the really healthy choices healthy for people so that they're available and so that they're cheaper. Pricing matters, you know. We have so many different food styles in Rich-mond, and that really has enriched our lives. We get to buy veggies, fruits and vegetables and things all year round, and the access is wonderful. The community as a whole really learns from that, too, to get to try differ-ent things. It works both ways. R. Sultan (Chair): Michael had a question. M. Sather: Yes, on your colour chart. My wife is an artistic soul, and when we're making dinner, she al-ways says: "Oh, we can't have the same colour of vege-tables on the plate. They have to be different colours." I always thought it was an artistic thing. Is there actually some nutritional benefit to having different-coloured vegetables together? K. Wong: Coloured vegetables means lots of nutri-ents, basically, so the brighter the colours, the more vitamins and minerals you have. Then there are phyto-chemicals and antioxidants and all those sorts of things thrown into the mix. But, yeah, if you get lots of bright veggies and fruits on your plate, you're going to get more vitamins and minerals, so you're going to do bet-ter that way. It looks better on the plate, too, you know. M. Sather: So the yellow is better than the white then? K. Wong: Yeah, I like the red and the yellow and the dark greens.

M. Sather: Interesting. R. Sultan (Chair): Dr. O'Connor wanted to interject. B. O'Connor: I just want to make a point about the immigrant population. I think we're going to see a large change because of what we call the globalization of health. In other words, the North American lifestyle, and particularly the American lifestyle, is now readily exported to just about every corner of the world in terms of KFC and McDonald's and Coca-Cola and Pepsi. The generation that's on the other end of this in-formation technology's ability to translate all these life-styles of the American population and to actually place these products in their home countries is really going to change the immigrant population and the obesity epidemic. This is a global epidemic. R. Sultan (Chair): Thank you, Dr. O'Connor. Back to you, Dr. Manson. H. Manson: I'll introduce Barbara Crocker, who is from Vancouver Community. You've heard from her once, but she's going to speak now specifically about some of the initiatives in Vancouver Community. She has only one slide, but she's going to speak at large to give you a lot more information. B. Crocker: We're back. The profile here is to look at the initiatives in Van-couver, just thinking about the differences between Vancouver, Richmond, the North Shore, Bella Coola, the Coast Garibaldi areas…. Vancouver is culturally diverse, as we know, and I've answered a question before about working with these various ethnic groups. There are a lot of services and supports for a variety of ethnic groups, and working with interpreters is part of that lens. We also have a magnitude of child poverty. If I go back to the late 1980s, the Vancouver school board in 1988 launched hot lunch programs in four inner-city schools. It took them ten years to launch that. We had teachers and administrators working in our four core inner-city schools that saw children coming in without lunch. They had tummy aches. They had headaches. Well, how could they address it? It took ten years. The hot lunch program was launched in 1988. In 1989 I became the school nutrition consultant, just as the wave of hot lunch programs was coming on the scene in Vancouver. It became the model for the prov-ince for the hot lunch programs that were launched in 1992. Vancouver went from those four schools to five schools to nine schools to 13 schools to 26 schools hav-ing a hot lunch program, and those programs do con-tinue today. In those early years the reports back were that fewer children going to see the nurse, sitting in the nurse's room, had tummies and headaches. The power of child hunger, the issue of food security, is real and alive. I mentioned earlier the issue of the Vancouver

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Food Bank, which started in 1980, then in 1988 we started with hot lunch programs. We have non-profit groups that sponsor breakfast programs in ten or 12 inner-city schools. During my years working with the Vancouver school board and schools, the lens was child hunger. My focus was inner city, looking at those communities and how we could provide supports.

[1140] In 1992 there was a child health promotion research competition. Premier Mike Harcourt announced it at an international congress for child health here in Van-couver. I sat there in the audience, and I said: "Yes, we need to apply for money." We had, like, a halo. We were feeding all these kids, but my question was: were we really meeting all of the families' food and nutrition needs by having a hot lunch program? There was kind of a glow that we had met all of the needs. We had the opportunity to go in and embrace two communities in a very broad way with cultural groups. We had a meeting with the eight translators, the parent groups, the school principal and so on, and in these two schools, we ended up developing cooking programs and recreation programs. One school had a hot lunch pro-gram, and one school did not have a hot lunch program. It was very interesting to go in with that. We worked with academics. We had UBC involved to help us with the process, which was very much a commu-nity development process, and hear the voice — what were families needing? — by asking teachers, etc. That led to this first model, Cooking Fun for Families. As you've heard from Kathy and Kay about cook-ing clubs and cooking, and we mentioned the high school years, children love cooking. Families do not have the cooking skills. They come to Canada, and they want to cook Canadian, which is pizza, burgers, fries, pop, etc. This is Canadian food, and the parents want to cook those foods for their kids because their kids ask for it. They want to fit in. As Kay said, the kids want to fit in and have those foods. We launched Cooking Fun for Families. It was basi-cally the spinoff of the program. Our handbook, Cooking Fun for Families, illustrates the two models. One had sports clubs and cooking clubs that were run by parents. This model for inner-city schools actually had paid staff. With Cooking Fun for Families, basically, I left it open for schools to approach me. In 1997 we finished the program. In 1998 school administrators started phoning. The reason the inner-city schools wanted this is that it was a way of welcoming parents into the school. They know that children are more successful in school when their families are connected to the schools. From an educational lens, having families involved in the school was very important, and this was an ex-cellent way to bring families in. What we found, in subsequent times, was that those parents went on to the literacy program, have gotten involved in the par-ent advisory committees and have really joined the community. The other thing about Cooking Fun for Families is that we've been able to branch out with skills for them

around FoodSafe, becoming leaders of groups and with the opportunity for them to launch beyond that. We did a second study — that's one of our posters here — and it did create social supports. Now, we have parents coming into the school, and it created social support for families who are new to the country, who don't know other people, don't know the school sys-tem, by having a place that was safe and welcoming. If we take off our hats and think about food in our families, about sharing a meal and what it means for families to come together for a meal…. In Washington State they have a program called Eat Together, Eat Bet-ter. They know it's not causal, but there's an association for families who eat together more often. The children do better in school. They're more so-cially connected, and they feel better. The more we can get families eating together, the healthier it is for those children. This model is about families coming in and cooking, sharing a meal and taking food home, learn-ing those skills within those schools. We've worked with a total of 12 schools. Okay, today. We've had a coalition over the past year to look at sustainability. We actually have six schools, I believe, that are now being funded by the Community Food Action Initiative, which is wonderful. Hike to Health also was a pilot project. It was funded through the Ministry of Health a number of years ago. It was basically looking at a response of pre-vention of cardiovascular disease and what we could do in communities. Hike to Health was helping those same inner-city-type schools. We worked in one school, parks and rec, to help parents get to the community centre, go skating, go swimming, go hiking on the North Shore mountains, go snowshoeing, go berry-picking — to get into the great outdoors. Parks and rec provided transportation. They had a healthy snack. It was a Saturday recreation program for families. School gardens. You've heard about some of the other programs looking at edible gardens and getting people connected. The vision for Vancouver inner-city schools is that all ten of those inner-city schools would have school gardens. We have two up and running. I believe a third one, Britannia, is wanting to have a garden. Children don't know where food comes from, and it's actually really fun to grow food. I don't know if any of you garden, but the excitement of seeing those flow-ers bloom or picking those cherry tomatoes and eating them….

[1145] When I do work with young families, and they say, "Barbara, my child won't eat fruits or vegetables," I'll tell them: "Go to the farmers market, get involved in a community garden, and get the kids picking the cherry tomatoes and eating them. Grow them yourself. Cook them." These are the ways that kids become more fa-miliar with food — through growing it, going to a market, tasting it, cooking it themselves. Gardens are very exciting things. We have a num-ber of community gardens, as well, in Vancouver, and we launched farmers' markets in 1994 in Vancouver.

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We had a big forum, and we invited the community and invited farmers. That led to the East Vancouver farmers' market. We now have three farmers' markets, and there's a provincial network of farmers' markets. A unique lens with that is that coupons were pro-vided to the women who were part of the Healthiest Babies Possible program. This is our pregnancy out-reach program for women at risk of having low–birth weight infants. This was a way for the women who were interested to increase their access to fresh fruits and vegetables, to come out to the market and be part of that view. Then when they have their children, they'll know the farmers' markets — which is, again, promoting fruits and vegetables. The Healthiest Babies Possible program also launched something called the Good Food bag — access to fresh, local, organic fruits and vegetables. The parents help to bag them, etc. It was so popular within Healthiest Babies Possible that they wanted to move it out into the broader community. The nutritionist and a number of people worked to create the Good Food box, which ran for a number of years but is now stopped. It may have another generation, but it's just in a hiatus right now. Back to cooking skills and the community kitchens coordinator. Back in the early '90s we had a woman from Montreal talking about collective kitchens, bring-ing people together to socialize around food — food as a social thing — and to use food to help bring people together for social means as well as skill-building. Through the work with the REACH community health clinic, the Vancouver Food Bank, Vancouver Coastal Health and Terasen Gas, which actually funded the community kitchen coordinator that we've had in place for the last ten years…. That position has enabled us to go from no community kitchens to over 100 com-munity kitchens, and that's enhancing our environment. A number of years ago, in 2002, we piloted a summer salad bar in five inner-city summer break programs. In the inner city in Vancouver, there aren't safe places for chil-dren. When we think about kids playing, you can't let your kids just run around in the neighbourhood. They'll run in the apartment buildings, and even that is not safe. Safe havens were created — Strathcona Community Centre and four schools, the KidSafe society — running five different programs in summer break. We thought: what a great opportunity to pilot a salad bar, looking at the opportunity to move that into the schools in the school year. The kids loved it. We had a partnership with the UBC farm. The kids went out to the farm on a field trip during the pro-gram. They ate salads every day during the summer program and loved it. They self-served, and they did the whole thing, eating all of this great stuff. The op-portunity for salad bars, I think, is excellent. Healthy Attitudes program. This is a little bit of a different lens. This is about interventions. When we think about promoting health and wellness, which has been most of what we've presented, we have to realize that in our community, there's a huge dieting culture. It's a multibillion-dollar dieting industry that's encour-aging women, children, youth to go on diets.

Diets don't help. They make the problem worse. They want people to buy special products. It's generat-ing this huge machine and this huge engine, and part of the outcome here is that we have body image con-cerns. We have children dieting. We have eating disor-ders, and we're all aware of eating disorders. The Healthy Attitudes program is an early inter-vention program to provide support to young people who are dieting, who have body image issues. We have a counsellor, a physician, a nutritionist and a commu-nity health nurse working as a team to support that. On