Executive summary: Our health our future – A national dialogue on healthy weights dialogue report
The number of overweight and obese Canadian children has risen steadily in recent decades. Today, more than one in four children in Canada is overweight or obese. Responding to growing concern of this alarming trend, in fall 2010 the federal, provincial and territorial (FPT) Ministers of Health and/or Health Promotion / Healthy Living endorsed Curbing Childhood Obesity: A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights. This document, which articulates a vision, strategies and priority areas for collaboration to address this issue, served as the foundation for a national engagement initiative.
Launched in March 2011, Our Health Our Future – A National Dialogue on Healthy Weightsset out to: inform Canadians of the impact of the issue; raise awareness of the factors that can contribute to childhood overweight and obesity; stimulate discussion on the issue and; encourage commitment to action to move toward healthy weights for children. This initiative will culminate with the National Summit, where stakeholders across the country will showcase best practices and propose concrete actions for the future. Upon completion, the key findings from this engagement process will be presented to the FPT Ministers of Health.
This report is divided into the five sections, including an introduction, the engagement approach, the participation profile, key findings and a conclusion.
The Our Health Our Future national dialogue brought together diverse groups of individuals and organizations to discuss ways of promoting healthy weights for children. A multi-stream engagement strategy provided Canadians with different ways to get involved. From March to September 2011, Canadians across the land participated through three participant channels.
- In-person events: Each dialogue was designed to allow participants to learn about childhood obesity and related issues; share their ideas, experiences and best practices and; reflect on possible actions for addressing this challenge. To maximize the opportunity for participation and interaction, a mix of small breakout groups and larger plenary discussions was used. These events were held in every region of Canada and engaged a diversity of stakeholder groups.
- Online conversations: An interactive, bilingual website was created at www.OurHealthOurFuture.gc.ca to act as a hub for online participation, where visitors could submit their ideas or comments through the Idea Forum and/or Submissions Area. A set of web-based tools enabled Canadians to share their ideas and engage in an online conversation on promoting healthy weights. Additionally, the broader objective of the website was to foster greater awareness and understanding of childhood obesity, and inform Canadians about current government actions (federal, provincial, territorial) to address this challenge. The website contained a suite of learning resources to help people learn about the issue in greater depth.
- Social media engagement: Facebook and Twitter were also used to gather input. A customized, bilingual presence was built for the Our Health Our Future initiative. Facebook users could like the initiative's profile page, post messages or links on the wall, respond to discussion questions posted by the moderation team, and share, vote and comment on ideas through an integrated Idea Forum. Traditional advertising, viral marketing and recommendations were used to further engage the Facebook community. The Twitter strategy was designed to bring together a network of thought leaders, researchers and stakeholder organizations to share information, perspectives and news on childhood obesity. The online conversation was facilitated by the Our Health Our Future project team, who posted discussion questions to initiate conversation between followers of the initiative.
The engagement approach was designed around the strategies and four policy areas outlined in the FPT Framework for Action document. The four topics for discussion were:
- Creating Supportive Environments: Ways to make the social and physical environments supportive of physical activity and healthy eating;
- Decreasing the Marketing to Children of Food High in Fat, Sugar and/or Sodium;
- Increasing the Availability and Accessibility of Nutritious Foods; and,
- Taking Early Action: Measures to identify obesity risks in children early.
Upon completion of the multi-stream engagement process, the research team analyzed all of the participant contributions.
The data findings from both in-person and online streams were carefully documented and analyzed by Ascentum, a third party public participation consulting firm. Specialized qualitative analysis software was used to identify the key shared themes and ideas that emerged.
Our Health Our Future heard from a wide range of individuals and organizations. Hundreds of Canadians participated in the in-person events held across the country, and more than 1000 participated online. The following table provides an overview of the participation levels by engagement channel.
|Engagement Channel / Contribution||#|
|Number of Events||20|
|Number of In-Person Participants||647|
|Comments on ideas||144|
|Votes on Ideas||477|
|Unique Website Visits||43,914|
Twenty in-person dialogues, held in 13 different cities across the country, engaged key stakeholder groups, including Aboriginal individuals and organizations, academics and researchers, caregivers, health care practitioners, industry representatives, non-profit health care and social organizations, media, provincial and territorial stakeholder groups, and youth. The coast to coast regional distribution of events demonstrates that Our Health Our Future was truly a national dialogue.
Online participation was also diverse and wide reaching, with participation from every province and territory, and some concentration in large urban centres. The level of online participation was tracked in a variety of ways. With 779 active contributions (i.e. total idea posts, comments, votes and submission), over 43,000 unique website visits, and a combined social media community of 772 individuals, Our Health Our Future was able to gather an even wider range of perspectives, while raising awareness around both the issue and initiative overall.
The multi-streamed engagement process attracted a wide range of participant perspectives. The top themes and ideas are organized under four discussion topics, which reflect the four policy areas adapted from the FPT Framework for Action.
1. Creating Supportive Environments
The most popular theme was education and training, which included three main ideas. The first was food preparation education in schools, to enable students to learn basic cooking and healthy eating skills. Participants suggested that this could be achieved by re-establishing home economics as part of the school curriculum, or by providing other types of experiential learning opportunities. The second idea was accessibility and availability of educational resources, which reflects the need to ensure that general information on healthy living is readily available to everyone. The third idea was nutrition education and literacy, which a number of participants believe should be integrated into the grade K-12 education curriculum across Canada.
The second theme under this policy area was built environment and infrastructure, which consists of three ideas. The first idea was urban planning conducive to physical activity – this included a number of actions to encourage active transportation and safe play throughout the community. The second idea was community access to school facilities, with participants proposing to open up schools to the wider community during evenings and weekends. This would help increase opportunities for free/low-cost physical activity while making use of underutilized facilities. The third idea was zoning legislation for improved access to healthy foods – this involves setting regulations related to the location of vendors that sell unhealthy foods, particularly those in close proximity to schools.
The third theme featured three ideas to influence positive behaviours and attitudes. The first idea was to institutionalize physical activity in schools, which would be done through various measures. The second idea was to shift focus away from weight, which was the most popular idea online. Many participants expressed concerns with the language around weights, and proposed using more holistic concepts, such as healthy living, and healthy growth and development. The third idea was inclusivity in sports and physical activity, whereby participants recommended reducing the focus on competitiveness in sports and encouraging both structured and unstructured physical activity of diverse types and for all skill levels.
Other common ideas that emerged included positive family lifestyle and environment, accessible recreation programs, and tax incentives.
2. Decreasing the Marketing to Children of Food High in Fat, Sugar and/or Sodium
In contrast to the other three policy areas, the ideas discussed for this topic were not organized into themes. Rather, they were treated as stand-alone ideas unique in relation to one another.
The first idea was stronger government regulations for marketing and advertising. This reflects a range of actions proposed by participants across all stakeholder groups to place greater restrictions on the marketing of unhealthy food to children. These actions reflect different degrees of stringency, which range from placing limitations on advertising during certain times and locations, to imposing a blanket ban on direct marketing to children. In general, most industry participants disagreed with the premise of this policy area, as well as the singling out of fat, sugar and/or sodium as unhealthy ingredients. The second idea was making the retail experience more conducive to the selection of healthy foods, which seeks to address how food is marketed and presented in retail environments. Many participants expressed concerns around visibility and accessibility of junk foods, particularly in high-impact areas (e.g. checkout aisles), and how this can influence food choices.
The third idea was media literacy for youth, which is aimed at teaching individuals how to critically analyze the messaging in a wide variety of media. Many participants viewed this as an essential component for addressing childhood obesity, as it would help empower children and youth to make better choices. The fourth idea under this policy area was positive marketing, which is an alternative framing of the topic. Rather than limiting marketing, this idea reflects a re-orientation to promote healthy food choices to children and youth more actively and creatively. Many participants who supported this idea felt that the media could have a potentially positive impact on this issue.
3. Increasing the Availability and Accessibility of Nutritious Foods
The most popular theme under this policy area was addressing food prices. The first idea was government regulation and policies to affect a decrease in the price of healthy foods and/or an increase in the price of unhealthy foods. This was proposed by participants representing almost all of the different stakeholder groups, with the exception of industry. Participants saw a role for government in regulating food prices, and proposed a number of actions, such as taxing unhealthy food items, subsidizing healthy food items, and developing a coupon system for selected healthy foods. The second and third ideas were aimed at supporting those communities that are particularly sensitive to food prices as a result of socioeconomic and geographic barriers. Many participants felt that supporting individuals with low incomes and individuals living in the North was essential to ensuring that healthy foods are truly accessible to all Canadians.
The second theme under this policy area was building community capacity, which involves three key ideas. The first was the promotion of community gardens –publicly available garden plots that promote food security and self-sufficiency at the local level, while also bringing community members together in a shared purpose. A number of participants discussed their experiences with community gardens and spoke to the positive impact that they have had in their respective communities. The second idea was to support local food production, which seeks to build the capacity of local food producers and make their products more accessible. A range of actions were proposed, such as promoting buy local initiatives, providing agricultural grants and subsidies, and coordinating efforts with schools. The third idea was community kitchens and meals, which would provide community members with a space to cook, share knowledge and skills and socialize with one another. This would help individuals share costs and time in preparing healthy meals.
Other ideas emerging from the in-person and online dialogues included convenient access to healthy food, product labelling, and access to and formulation of junk food.
4. Taking Early Action
Education and training was the most popular theme emerging from discussions under this policy area, and evolved around two ideas. The first idea was to engage parents and families. Many participants want to ensure that individuals have the knowledge and resources needed to guide their children towards healthy behaviours and choices. This could be achieved in a variety of ways, such as instructional courses, information sessions, social marketing campaigns and/or information packages. These types of initiatives could also leverage community-based partners, such as schools, caregivers and the local media, to get the message out. The second idea was supporting practitioners to ensure that they have access to relevant, up-to-date educational resources and training opportunities. Many participants felt that both healthcare and childcare practitioners needed to be equipped with the skills to identify and address childhood obesity through their work.
The second theme under this policy area was maternal and baby health initiatives, which includes two ideas. The first is to encourage breastfeeding. Many participants, especially caregivers, promoted breastfeeding as a fundamental component of early childhood health and nutrition. As a result, many believed that it should be the exclusive feeding practice for the first six months to one year of the child's life. The second idea was pre- and post-natal services, which would represent a comprehensive continuum of services available to mothers and families. This includes improved surveillance and monitoring and access to education and counselling on relevant topics such as prenatal nutrition and birth weights.
The third theme was the need for further research. Two ideas were put forward, both aimed at improving the overall research capacity and data currently available on childhood obesity in Canada. The first idea was to assess health needs and risk factors. Participants suggested that a comprehensive and standardized assessment would not only produce robust, accurate and up-to-date research on the issue, but it would improve the overall process for determining when and where to make interventions. The second idea was improved health monitoring and tools, which would utilize effective, world-recognized tools like the World Health Organization (WHO) growth charts. This idea also represents actions to re-examine current monitoring practices, which many participants felt were inadequate because they did not account for the comprehensive set of factors that can impact a child's growth and development.
The Our Health Our Future engagement process succeeded in engaging a diversity of stakeholders from across Canada in an informed dialogue on how to promote healthy weight for children and youth. Their input will help inform the work of the FPT Ministers of Health as they move forward to determine future action on this issue. Equally important, the engagement process has also created numerous opportunities for collaboration among stakeholders from industry, the not-for-profit sector, families and researchers.
Based on participant evaluations, the majority valued the dialogue opportunity, appreciated the freedom to express their views freely and the effectiveness of the facilitation, and was satisfied that the session objectives were met. Some participants were so keen that they expressed a desire for even more time for discussion.
The results of this national initiative reveal a strong appetite for concerted and coordinated multisectoral action to reverse the trend of childhood obesity. Participants know that sustained action and long-term commitment means governments, families, communities and industry must make this a priority. They are prepared to join together in this critical first step to addressing childhood obesity in Canada.
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