2. Invest in Integrated and Collaborative Approaches to Health Promotion and Healthy Living

BCHLA’s past submissions have put forward positive recommendations to make the healthy choice the easier choice for British Columbians. The percentage of people with serious chronic diseases in British Columbia is growing as our population ages. Policies and programs that make healthy choices easier will lessen this trend if we act today. Broad-based population measures will bring about behaviour change that will prevent chronic disease and benefit everyone.

BCHLA recognizes that there are many individuals in our society who face major barriers to healthy lifestyle changes. While some of these individuals may understand the changes they need to make to lead a healthier life (healthier food, more physical activity) they may not have the resources or access to make these positive lifestyle choices.

BCHLA has fifteen health promotion initiatives coming to a close in communities across this province. These initiatives are integrated, evidence-based, and targeted to populations and geographic areas where the need is high. They were designed to change the behaviour of British Columbians who have multiple barriers to healthy living and are hard to reach using traditional methods. This informed, collaborative and integrated approach is the BCHLA advantage. 

BCHLA initiatives are impacting over 165 British Columbian communities from Ahousaht to Cranbrook, West Moberly to Victoria. Our initiatives have reached out to First Nations, urban, rural and remote communities some which were ready to implement healthy living activities and others which needed capacity building in order to take the first steps towards a healthier future. The individual reach of many of our community-based activities have not yet been confirmed. However, preliminary data indicate that our Targeted Education initiative aimed at 19-29 year old tobacco users, “Quitters Unite”, reached over 165,000 students at ten post secondary campuses across the province. Thirteen thousand, six hundred twenty-six workers received the information they needed to kick the tobacco habit or help their co-workers do so. Over 6,000 schools, vendors and parents have accessed resources provided by our School Guidelines Support initiative to ensure that they know what options are the best ones to serve our kids. Nine thousand four hundred families have learned to shop, cook, eat and drink in a healthier way. Communities have received grants to help plan for walking trails, promote walking events, create community gardens, get kids playing hockey and develop youth leadership in small towns. We look forward to sharing our results in 2010.

BCHLA has partnered with the Michael Smith Foundation for Health Research to evaluate the success of our initiatives. This partnership ensures an arms-length perspective and avoids duplication of effort. The research will inform us on the next steps we need to take — where we should be expanding on initiatives that work well and which approaches should be adapted.

Despite the difficult financial times, BCHLA urges the government to continue to invest in integrated and collaborative approaches to health promotion and healthy living. Behaviour changes take time and although the evidence is growing about the impact of healthy living on the prevention of chronic diseases — from breast cancer, other cancers, diabetes, heart disease and lung disease — there is still much work to be done. It is important to focus on comprehensive and integrated strategies at a local level as well as maintaining traditional educational approaches to reach and influence behaviour. Health care costs will continue to escalate unnecessarily if we do not invest in prevention enabling individuals to live healthier lives.  

BCHLA recommends that the BC government invest in the “Six Percent Solution” allocating an additional 3% of current health dollars to public and population health approaches to prevent chronic disease and lessen the load on the health care system.

The returns on investments in healthy living are well documented and provide a persuasive economic justification. In addition to BCHLA’s costs analysis, a Trust for America's Health Report concluded that an investment of $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent tobacco use could start to pay off within five years.⁵ 

The following are key areas in need of the government’s support.

2.1 Improve the Infrastructure for Active Transportation

BCHLA recommends that at least 7% of all infrastructure funding allocated to urban transit, road and other transportation construction, should be set aside for Active Transportation infrastructure (e.g., bicycle facilities, walking trails/paths, sidewalks, signals, signage and traffic calming measures).

BCHLA applauds the government’s investment, including $31 million for Bike BC and the $40 million LocalMotion Fund, to build pathways for British Columbians to cycle, walk, run and roller blade, but more investment is needed to meet the suggested 7% target. For example, the Gateway Program initiated as a response to the impact of growing regional congestion, and to improve the movement of people, goods and transit throughout Metro Vancouver is a $3 billion project. Only $50 million has been allocated to cycling and pedestrian infrastructure which accounts for a mere 1.7% of the total spending. Unfortunately these figures come nowhere near the 7% that we believe is vital to helping communities build physical activity into the daily routines of citizens.

This investment in active transportation will result in a two-fold benefit: assist BC communities in achieving their climate change targets as well as decreasing the incidence of chronic disease.

Investments in active transportation infrastructure support local government efforts to take action on climate change through greenhouse gas (GHG) reduction. In BC, 30% of GHG emissions are from cars and light-duty trucks, with the average trip distances less than 5km. For these short trips, cycling and walking can play a significant role in combating climate change. Improvements in pedestrian and cycling facilities will result in increases in walking and cycling as modes of transportation for short trips. Encouraging active transportation for short trips reduces single occupancy vehicles which reduces congestion and leads to more efficient transportation networks.⁶

Investment in active transportation infrastructure further supports Bill 27 legislation which allows local governments to use money received from off-street parking to fund transportation infrastructure that supports walking, bicycling, public transit or other sustainable forms of transportation.

Evidence is increasingly clear that many chronic diseases can be prevented through lifestyle changes which include Active Transportation and regular physical activity. However, we need the supportive environment to be physically active. Smaller communities in particular need assistance in accessing resources to expand and improve the infrastructure that supports their populations to be active.

Research conducted by Dr. Larry Frank, Bombardier Chair in Sustainable Transportation at the UBC School of Community and Regional Planning, found that adults are 2.5 times more likely to engage in active transportation when living in compact and well connected neighbourhoods. They are also more likely to get the recommended amounts of daily physical activity.⁷

A report by the Provincial Health Services Authority found that there is “a growing consensus among public health experts that supporting more physically active modes of transportation and better access to recreational opportunities offer the most effective ways to increase activity levels across the population. Walking and cycling are among the most popular physical activities, particularly among people who are overweight and/or inactive, while programs to promote physical activity through gym memberships, school activities and other interventions have had only limited success”.⁸

BCHLA’s Winning Legacy report shows that physical inactivity costs the BC economy a total of $621 million annually in direct and indirect expenditures.

2.2 Encourage Participation in Physical Activities

BCHLA recommends that the BC government exempt sporting goods and recreation programs and services from HST to encourage participation in physical activities. 

BCHLA is encouraged that as of July 2010 less healthy foods which currently incur GST will be taxed at the HST rate of 12%. However, we do have concerns that the implementation of HST in BC will increase the costs to those wishing to get involved in physical activities to improve their health.

For instance, sporting goods (including bicycles) and recreation programs and services are currently exempt from PST. Our fear is that an additional 7% tax added to these activities and equipment may deter people from choosing to engage in more physically active behaviours. For those on lower incomes, this will be an even heavier burden and deterrent to involvement. We would therefore suggest that the BC government exempt sporting goods and recreation programs and services from HST.

Given that children’s clothing is subject to GST but exempt from HST we believe that exempting sporting goods and recreation programs and services from HST would also be achievable.

BCHLA recommends that the BC government dedicate ongoing resources to support community initiatives that promote physical activity opportunities.

Since 2005, the Active Communities Initiative of the BC Recreation and Parks Association has successfully mobilized some 226 local governments and aboriginal communities to undertake actions that promote healthy lifestyles and build healthy communities while increasing physical activity levels. This initiative was a key component of the provincial government’s health goals including the 20% by 2010 challenge, and a conduit for ActNow BC. Over $935,000 in grants has been awarded to communities throughout the province to support physical activity programming, the building of trails and walkways, and active events. 

To celebrate the work of these registered Active Communities across the province, 52 success stories have been published and circulated widely. This initiative also supported 237,391 people across the province to get active on the internationally recognized Move for Health Day.

In August 2009, funding for this initiative was completely eliminated from the allocations from the BC government. BCHLA recommends that the BC government reinstate this funding and dedicate continued resources to enable the Active Communities Initiative to produce systemic changes in policy, physical and social environments required by communities to sustain the momentum towards an active, healthy British Columbia.

2.3 Support School Health and Wellness Initiatives

BCHLA recommends that the BC government continue to support School Health and Wellness Initiatives (e.g. School Fruit and Vegetable Nutritional Program and Action Schools! BC) including the implementation of the Guidelines for Food and Beverage Sales in BC Schools.

British Columbia was one of the first provinces to implement policy on the sale of food and beverages to students in K-12 schools. Many schools across the province have moved forward with implementing the Guidelines for Food and Beverage Sales in BC Schools but it has been a challenging process for many school staff, volunteers, parents, and the food industry.

Having access to supports, tools and personnel that make the job of those responsible a little easier means better policy acceptance and compliance. Without continued support for schools, compliance will fall short and providing healthy food and beverage choices to students in BC schools will become less of a priority among the many competing priorities for schools.

The online tool – Brand Name Food List (www.brandnamefoodlist.ca) — has guided schools and parents by providing easy access to a constantly updated online list of foods and beverages that meet the Guidelines while at the same time it has encouraged the food industry to reformulate their products to meet these requirements. We recommend that the government dedicate funding to ensure schools, and those that supply foods to schools, continue to have access to a current database of foods and beverages that meet the government Guidelines.

The World Health Organization has identified a health promoting school environment as one of five key strategies for addressing growing trends in obesity and overweight. Our province is fortunate to have two internationally recognized programs that promote healthy and active lifestyles in BC schools. While we are pleased that the BC government has supported such progressive initiatives we are concerned that recent cuts to these programs may have an adverse effect on the progress they have made thus far.

The BC School Fruit and Vegetable Nutritional Program is part of ActNow BC and is a very positive program. Similar programs in the United Kingdom and United States have been very successful and positively received by children, parents and teachers.⁹ The fresh and nutritious fruits and vegetables to be served in this program are grown in BC, subject to availability. Serving BC grown fruits and vegetables enhances the market for locally produced food products, contributes to the sustainability of rural communities and economies and raises awareness of the importance of maintaining local agriculture as a source of food.

By January 2010 the BC School Fruit and Vegetable Nutritional Program is expected to reach 1,160 schools and over 300,000 students. At present the program is only funded until June 2010. We recommend that the BC government dedicate funding to continue this internationally recognized program.

Action Schools! BC is a best-practices physical activity and healthy eating model designed to assist elementary schools in creating individualized action plans to promote healthy living. According to the BC Select Standing Committee on Health, 27% of children in BC aged 2-17 are overweight or obese.¹⁰  Inactivity and unhealthy eating habits are the major contributing factors to these staggering trends.¹¹  These trends are of concern because of the growing evidence linking healthy child development to chronic disease prevention.

Action Schools! BC has recently had its funding cut by 50% which will certainly impede the progress it has made to date and prevent expansion to secondary schools which is essential to supporting children to be active and eat healthy at a time when physical activity levels often fall off, especially in girls, and eating habits deteriorate.  We recommend that the BC government reinstate this funding and dedicate continued resources to enable Action Schools! BC to influence positive behavioural shifts at all stages of the educational experience, K-12.

These programs are in high demand and have made tremendous progress despite their stretched resources. Schools are important places to focus resources as most children live within walking or cycling distance of school and youth is a formative time in the development of eating and activity behaviours. Dedicated and ongoing funding for multiple-year programming is required to enable organizations to influence behaviour shifts in target populations.

2.4 Subsidize smoking cessation initiatives

BCHLA encourages the BC government to subsidize cessation initiatives and nicotine replacement therapies with funds generated by increasing tobacco taxes. 

Smoking is still the single largest cause of preventable death, killing 6,000 British Columbians annually. Providing supports to people who want to overcome nicotine addiction will be an investment that pays dividends in lower health costs, healthier environments and a healthier population. 

BCHLA was pleased that this government took an innovative step by supporting funding on an ongoing basis to QuitNow as well as providing nicotine replacement therapies for smoking British Columbians on income assistance. According to a survey commissioned by the Canadian Cancer Society, British Columbia and Yukon Division, “a high percentage of BC residents (87%) say they would support allocating a small portion of money from the sale of tobacco products to a fund that would subsidize the cost of cessation products, such as the nicotine patch and nicotine gum, for smokers who wish to quit.”¹² 

Tobacco tax increases are a strong and proven disincentive to tobacco use. And yet, interventions should be responsive to the higher prevalence of tobacco use among lower income British Columbians who have fewer resources for quitting. Targeting cessation counselling and nicotine replacement therapies to low income British Columbians may mitigate the burden of added taxes while providing an incentive to overcome the negative health effects and ongoing cost of tobacco addiction. 

2.5 Enhance and Expand Smoke-Free Measures

BCHLA recommends that the BC government expand on its smoke-free legislation to include tobacco-free pharmacies.

BCHLA applauds this government for its efforts to ensure smoke-free places and we encourage you to continue to protect children and adults from exposure to second-hand smoke by exploring other areas where we can build on this legislation. In particular BCHLA would like the government to legislate for tobacco-free pharmacies.

Nine Canadian provinces and territories (Ontario, Québec, New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland and Labrador, Northwest Territories, Nunavut and, most recently, Alberta) have adopted legislation to prohibit the sale of tobacco products in pharmacies. Outside of North America, it is practically unheard of for tobacco products to be sold in pharmacies. Health care professionals argue that pharmacies should be centres of wellness and by selling tobacco products, pharmacies are condoning a product that is the single largest cause of preventable death. Selling tobacco products is entirely inconsistent with the profession of pharmacists, just as it would be unthinkable for cigarettes to be sold in a doctor’s office. It is a conflict of interest for pharmacists to sell an addictive drug which makes people sick, and at the same time sell medications to make people better. Selling tobacco products in a pharmacy sends the wrong message to children and undermines educational and tobacco cessation initiatives.

A report from the Physicians for a Smoke-Free Canada¹³  which reviewed the effect on Ontario pharmacies after a ban on tobacco sales was implemented, found that “the claim by pharmacists that tobacco revenue is necessary to sustain their operations does not seem to be consistent with the available facts”. In addition it found that “data reported by the Ontario College of Pharmacists shows that there is no demonstrable difference in the number of pharmacy openings and closings in the year following the ban than the two years preceding the ban.”

While BCHLA believes that tobacco-free pharmacies should be a priority for the BC government, we also believe that the BC government should develop provincial standards for smoke-free patios, tobacco-free parks and beaches, and ensure consistency of distances for smoke-free areas in front of buildings.

2.6 Support Rural and Remote Communities’ Access to Healthy Food 

BCHLA recommends that the BC government provide community capacity building opportunities to assist citizens in accessing fresh produce in rural and remote communities.

BCHLA recognizes that residents in the north, rural and remote communities face significant barriers to healthy eating – particularly with the high cost relative to income and the local availability of fresh produce. For example, a bag of carrots that costs just $2 in the Lower Mainland will cost a resident that lives nine hours north of Prince George $5.

The research BCHLA undertook to inform our Healthy Eating Initiatives found that 14% of families in BC find themselves in situations where accessing enough healthy food is problematic. The research also found that although there is a growing interest in supporting local food systems, there is no reliable system in place that makes BC grown foods readily available to BC families.

We were pleased with the Premier’s announcement last year of a Task Force to look into the issues involved in providing fresh produce to northern and remote communities and we urge the BC government to implement recommendations from the work of the Task Force to increase supplies of local, healthy, sustainable and safe food to those in rural and remote communities. We would also ask the BC government to explore long-term solutions to sustainable food security in these areas to ensure that all citizens have access to fresh and healthy food year-round.

2.7 Introduce measures to ensure affordability of healthy food and beverages

BCHLA recommends that the BC government introduce measures such as a tax on unhealthy foods or working with the food and beverage industries on pricing strategies to ensure affordability of healthy foods and beverages. 

BCHLA commends this government for its commitment to removing unhealthy food from schools and publicly funded buildings. We feel these are important first steps to help make healthy choices easier choices for the citizens of this province. But to address the childhood obesity epidemic, which shows no sign of abatement, more needs to be done. Specifically, we need to decrease the appeal of unhealthy foods by either increasing their cost or decreasing the cost of healthy foods.

Tax disincentives are currently used to discourage smoking and excessive alcohol consumption. The pressure on health care resources caused by the obesity epidemic provides ample justification for applying a comparable tax disincentive to unhealthy foods.

The BC government has already developed excellent Guidelines for Food and Beverage Sales in B.C. Schools that outline the types of foods that are “not recommended” due to their low nutritional value and high calorie content. BCHLA recommends that the BC government use these existing guidelines as criteria for determining the types of food that are taxed. 

BCHLA believes that the funds generated by this food tax could be used to help support and broaden initiatives that ensure affordability of healthy food and beverages. We do not wish to see individuals and households unable to afford food, but rather to make healthy food affordable in all communities in BC.

Another alternative would be for the BC government to work on a pricing strategy with the food and beverage industry to ensure that healthy foods are less expensive than unhealthy foods. If the province is to combat this obesity epidemic it must work with industry to make healthier choices the easier and more affordable choice for consumers.