1. 1 Federal Advocacy Initiatives in Nutrition: The Case of Trans Fats and Sodium OSNPPH Conference Toronto, June 1, 2007 Mr. Stephen Samis Director Health Policy Heart and Stroke Foundation of Canada

2. 1.Why trans fats? 2.Trans Fat Task Force: What is it, where did it come from & what did it do? 3.Final recommendations from the Trans Fat Task Force 4.Future of trans fats: where do we go from here? 5.Sodium challenge/approach Overview

3. Why Trans Fats? Significant body of evidence linking trans fats and coronary heart disease Canada has one of the highest rates of trans fat consumption in the world Canadians are becoming increasingly concerned about trans fats Progress has been made. More needs to be done.

4. Daily trans fatty acid intake in various countries (based on analysis of dietary records) NS PQ USA BEL DEN FIN GRE SCOT FRA GER ICE ITA NET NOR POR SPA SWE UK AUS NZ COUNTRY TFA g/person/day BC W.M.N. Ratnayake and C. Zehaluk (2005). Trans Fatty Acids in Foods and Their Labeling Regulations: In "Healthful Lipids" (Edts. C.C. Akoh and Oi-Ming Lai), AOCS Press, Champaign, Illinois, pp. 1-32.

5. Evidence of Health Risk from Trans Fat –High consumption of trans fats leads to threefold (3.3 times) increase in risk of heart disease Harvard School of Public Health, November 14, 2006. –Trans fats pose 5-6 times higher risk of ischemic heart disease per gram than saturated fats (Dr. Steen Stender, presentation before Trans Fat Task Force, November 2, 2005). If trans fats were replaced with healthier alternatives, an estimated 3,000-5,000 cardiac deaths a year would be averted in Canada. Harvard School of Public Health data.

6. Scientific Recommendations Dietary Reference Intakes, Institute of Medicine (2002): –it is recommended that trans fatty acid consumption be as low as possible while consuming a nutritionally adequate diet Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases (2002): –limit energy intake from trans fat to less than 1% of energy

7. Environics Polling Results In your opinion, what impact do trans fats have on your health? Sept. 23–Oct. 12, 2004 Sample size n=2027, +/- 2.2%, 19 times out of 20 Good for your health 4%Neutral15% Bad for your health62%DK/NA17% Sept. 19–Oct. 16, 2005 Sample size n=2024, +/- 2.2%, 19 times out of 20 Good for your health 4% Neutral 12% Bad for your health75%DK/NA 9%

8. Initial Canadian Government Intervention On January 1, 2003 Canada became the first country to approve regulations requiring the mandatory labelling of the trans fatty acid content of foods. The new nutrition labelling regulations came into effect on December 12, 2005 (except small business – Dec 07)

9. PRODUCTTRANS FAT CONTENT (GRAMS) # OF TIMES OVER THE TRANS FAT LIMIT* HEALTHIER PRODUCT OPTION TRANS FAT CONTENT (Grams) Nico(soft tub) Margarine 1.5g/10g3.75xBecel Non-hydrogenated Margarine 0 Loblaws No Name Breaded Fish Sticks 2g/100g3.6xBlue Water Fish Sticks (Haddock)0 PC Natural Flavour Microwaveable Popcorn 5g/50g7xOrville Redenbachers Smart Pop0 Old El Paso taco shells 1.5g/2 shells6.6xWonder + Wrapz 100% Whole Wheat Tortilla 0 McDonalds Happy Meal: Four chicken nuggets, small French fries and apple juice 2g1.6xMcDonald's Hamburger; side salad with low fat Italian dressing; fruit 'n yogurt parfait; water 0.2g McDonalds Baked Apple Pie 5g7.2xMcDonald's apple slices with caramel 0g Burger King Hash Browns 10g/128g8.4xBurger King Baked Potato (no margarine or sour cream) 0g Burger King Kids French Fries 3g/74g5xBurger King Baked Potato (no margarine or sour cream) 0g Burger King Berry Turnover 6g/87g7.6xN/A

10. Stricter Interventions in Other Jurisdictions March 2003, Danish Veterinary and Food Administration introduced a limit on trans fat content of fats and oils sold as such or when used in foods of not more than 2% of fatty acids (excludes naturally occurring trans).

11. October 2004 - Pat Martin (NDP) re- introduces Commons Bill C-220 to limit the amount of trans fat in foods November 23, 2004 – NDP motion passed by the House of Commons November 2004 - Minister of Health commits Health Canada to work with the Heart and Stroke Foundation of Canada through a multi- stakeholder task force Increased Political Pressure

12. NDP Motion – November 23, 2004 Passed 193-73 That, in the opinion of this House, the federal government should acknowledge processed trans fatty acids are harmful fats, which are significantly more likely to cause heart disease than saturated fats; And that this House hasten the development of replacements to processed trans fats by urging the government to enact regulation, or if necessary legislation within one year, guided by the findings of a multi- stakeholder Task Force, including the Heart and Stroke Foundation of Canada and following the consultation process with scientists and the industry currently underway; Therefore, this House calls on the government to enact regulation, or if necessary present legislation that effectively eliminates processed trans fats, by limiting the processed trans fat content of any food product sold in Canada to the lowest level possible.

14. 2. Creation of Trans Fat Task Force Task Force mandate: –To provide the Minister of Health with concrete recommendations and strategies to effectively eliminate or reduce processed trans fats in Canadian foods. End of mandate: April 2006

15. Task Force Membership 20+ members Co-chairs –Health Canada –Heart and Stroke Foundation of Canada Government Industry Associations NGO Sector/Consumer Groups Scientific Experts

16. Estimated Health Benefits of Regulation A 2% upper limit of processed trans fats will prevent at least 2,000 heart attacks per annum in Canada, 800 of which would have been fatal. -(Estimates supported by Dr. Walter Willett, Harvard School of Public Health)

17. 3. Task Force Recommendations A unique Canadian approach to: –significantly improve the heart health of Canadians –reduce trans fat consumption amongst Canadians, particularly those at the highest consumption levels –ensure average daily intake of trans fats represents less than 1% of energy intake

18. Task Force Recommendations An evidence-based, regulatory approach to: Make trans fat recommendations consistent with food labelling Speed development of alternative oil sources Ensure benefit for all Cdns, not just who can afford to pay more for trans free products Level the playing field for all in food industry

19. Task Force Recommendations: A dual Approach Trans fat content be limited to 2% of total fat of all vegetable oils purchased by a retailer or food service for preparation of foods on site. Trans fat content of all other food be limited to 5% of total fat. This includes mixed foods (natural and processed trans). Excludes foods where trans fat is entirely from ruminant source (e.g., beef, lamb).

20. Trans Fat Task Force Report broadly supported Consensus report Strong public acceptance Addressed many concerns of industry Oilseed growers, like the Canadian Canola Council indicate that regulations will not have a negative impact on their sector Canadian Restaurant Foodservice Association supportive of federal action

21. Why Regulations? Trans fats reduced in foods where easiest. Many foods still very high in trans fats. Still high in many restaurant foods where labeling is not required. Foods low in trans often costlier than identical foods that contain high levels of trans. Regulations work (removal of lead from paint, food labeling, seat belts, toxic chemicals, etc). Denmark did it! New York doing it! Calgary? Toronto? Vancouver?

22. Not Proceeding with Regulations? Missed opportunity to prevent CVD and reduce health care costs. Canada goes from international leader to follower. Will not facilitate reduction among difficult products. Will not facilitate reduction among young males and people of low income. Will not send strong signal to oilseed growers and producers to produce healthier alternatives. Public backlash – public believes government proceeding.

23. 4. Future of trans fats: Where to from here? 1.Federal Governments Lack of Response (June 07 = 1 year!) 2.Possible: –Publication of draft regulations in Canada Gazette, Part 1 –Consultations and final regulations promulgated –Regulations in effect by 2009 and full implementation by 2011 3.Necessary: –Advocacy on part of health and nutrition groups, consumer associations and other Canadians

24. Hill Times Ads Nov 6 & 20

25. Leaflets for Parliamentarians

26. What You Can Do? Write to the Minister of Health, Hon. Tony Clement and to the Parliamentary Health Secretary, Mr. Steven Fletcher Contact Senator Wilbert Keon Contact your MP Start a petition Advertise in Media Provide information to public in your communities and ask them to act

27. 5. The Sodium Challenge and Approach Average Canadian sodium intake = 3100 mg/day New Cdn Food Guide = 2400 mg/day WHO recommendation = 2300 mg/day Up to 17% (1 in 5) of hypertension associated with high dietary sodium

28. Sodium Reduction: Effects Cutting the average Canadians salt intake by half would: eliminate hypertension in one million Canadians double the number of Canadians with adequately controlled hypertension save the health-care system $430 million a year

29. Reducing Sodium in the Food Supply Sodium is not trans fats = different approach required Consultation and collaboration are crucial Work with food industry and government Consumer education/awareness = behaviour change

30. Blood Pressure Canada and Cdn Hypertension Education Program Focusing on sodium reduction – early stage Established Sodium Reduction Task Force (HSFC, BC Cda, DC, others) Establishment of policy paper to reduce Canadian Sodium consumption by 2014 and to 2300 mg/day by 2020 Approval by SRTF member organizations Consultation with the food industry (Toronto, April 07) Collaboration with Health Canada

31. Recent Activities/Efforts FCPC and DC colloquium on sodium SRTF consultation with the food industry (Toronto, April 07) Collaboration with Health Canada – looking at British model of sodium targets and tactics Approval of policy paper by SRTF member organizations Work with food industry to change food supply HSFC = grow # and types of foods in Health Check program

32. For More Information… Go to the Trans Fat website at www.healthcanada.ca/transfat www.healthcanada.ca/transfat Visit HSFC at www.heartandstroke.ca Check out Canadian Hypertension Education Program www.hypertension.ca/chep/