No time to wait: Healthy kids in the Sudbury and Manitoulin districts

Released in March 2013, the Healthy Kids Panel (HKP) No Time to Wait: The Healthy Kids Strategy, outlines a bold, yet feasible and achievable three-part strategy – that will have the greatest positive impact on child health.

The strategy calls for child health to be everyone’s priority and for players within and outside of government and for parents, caregivers and youth to:

Start all kids on the path to health
Change the food environment
Create healthy communities

Report Card

Overall grade on SDHU Actions to Achieve Healthy Kids: B

Start all kids on the path to health: SDHU grade: B
Change the food environment: SDHU grade: C+
Create healthy communities: SDHU grade: A

Introduction

In January 2012, the Ontario Government set an ambitious target to reduce childhood obesity by 20% in 5 years. That May, the Minister of Health and Long-Term Care established the Healthy Kids Panel (HKP) to recommend a strategy to meet that target. The Sudbury & District Health Unit (SDHU) was privileged to be represented on the Panel with the participation of its Medical Officer of Health.

Boards of health are key government players in society’s efforts to reduce rates of childhood obesity. Under the Ontario Public Health Standards, the SDHU has a mandate to promote healthy weights and prevent obesity, and many of the HKP Strategy recommendations are relevant to this mandate.

The SDHU evaluated its current healthy weights programs and services against the HKP’s 23 recommendations. Our overall self-evaluation grade is a B[i]. We identified what works well, what we need to do more of and what we need to do differently. The details of the SDHU self-evaluation and next steps to improve our grades are described in this report card.

The SDHU strongly agrees with the HKP that there is no time to wait. Concerted, coordinated and collaborative efforts across all sectors of society are required now and local public health needs to do its part.

Rates of overweight and obesity in all age groups have been climbing steadily over the last few decades.

Sixty per cent (60%) of the SDHU population 18 years and over is considered overweight or obese (ON: 51%), and 29% of area youth aged 12 to 17 years are either overweight or obese (ON: 21%) (Ministry of Health and Long-Term Care). The problem is more severe for boys than girls and for Indigenous children. As they age, our overweight and obese kids are more likely to develop diabetes, high blood pressure, heart disease and arthritis. As they grow, they are more likely to be bullied, stigmatized and excluded. No one wants this for a child, not their son, daughter, niece, nephew, grandchild, preschooler, or student.

Changing this weight trajectory that is over 30 years in the making will require action from all sectors of society—private, non-profit, media, municipal and provincial government. The SDHU invites all sectors to undertake a similar self-evaluation against the HKP’s 23 recommendations and then to come together to collectively do our best to ensure healthy kids in the Sudbury and Manitoulin districts.

A word about obesity and the SDHU approach

Obesity is a complex issue that requires complex solutions. Obesity and overweight are influenced by many factors including social and economic conditions. Not everyone has the same opportunities to achieve a healthy weight. Raising healthy kids is a challenge for everyone but it is particularly difficult for Ontario families who have fewer means. It is also known that health behaviours develop in early childhood. These behaviours impact weight and are influenced by the adults in children’s lives. They are also influenced by the many environments in which children live, learn, and play.

The work of the SDHU is informed by our understanding of the complex nature of obesity. We use a Balanced Approach Philosophy to guide all healthy weights related programming. With this Philosophy, body measurements are not seen as the sole indicator of health. Instead, health and a healthy weight are achieved and maintained through a healthy lifestyle that includes eating well, being active every day, and feeling good about one’s self, at every size. The SDHU also strives to reduce inequities in health, recognizing the importance of underlying social and economic factors.

Quote from HKP report, p.10

“Health is about more than weight. In fact, a child who is a little overweight and who is fit and active is healthier than a child who is the ‘right’ weight for his or her age and height, but is more sedentary. Focusing too much on weight is stigmatizing and will not address many of the factors that contribute to unhealthy weights.”

Report Card on SDHU Actions to Achieve Healthy Kids

Healthy Kids Strategy Part 1: Start All Kids on the Path to Health – SDHU Grade: B

1.1 Educate women of child-bearing age about the impact of their health and weight on their own well-being and on the health and well-being of their children (SDHU plays a key role in achieving the recommendation)

1.2 Enhance primary and obstetrical care to include a standard pre-pregnancy health check and wellness visit for women planning a pregnancy and their partners

1.3 Adopt a standardized prenatal education curriculum and ensure courses are accessible and affordable for all women (SDHU plays a key role in achieving the recommendation)

1.4 Support and encourage breastfeeding for at least the first 6 months of life (SDHU plays a key role in achieving the recommendation)

1.5 Leverage well-baby and childhood immunization visits to promote healthy weights and enhance surveillance and early intervention (SDHU plays a supportive role in achieving the recommendation)

Quote from HKP Strategy, p. 20

“The first 2,000 days of child’s life—from conception to school—play a critical role in ‘programming’ his or her health, ability to learn and ability to relate to others (i.e., social functioning) later in life.”

What are the key SDHU actions on the recommendations for starting all kids on the path to health?

The SDHU offers a variety of programs and services promoting health throughout the lifecycle. A standardized prenatal education program, informed by evidence, is available at no cost across the districts to all expectant mothers and their partners, and supports are available to overcome barriers if they exist.

Recent trends indicate that up to 57% of first-time mothers in the SDHU service area do not take prenatal education (Niday, 2010). In an effort to increase accessibility, the SDHU will be launching an online version of our prenatal program later this year.

To protect, promote and support mothers in their decision to breastfeed, the SDHU is also pursuing its Baby Friendly Initiative (BFI) designation. The SDHU runs a breastfeeding support group, which assists mothers with breastfeeding duration and exclusivity. Our Healthy Babies Healthy Children program supports pregnant women and parents of children under 6 years of age. This free and confidential service provides parents with advice and support about pregnancy, breastfeeding, and parenting, and links families to supports in the community. If needed, families without a health care provider are referred to the SDHU Growing Family Clinic for one-on-one support.

84% of SDHU area mothers initiated breastfeeding with their newborn. However, rates declined significantly over time, with only 55% of mothers still breastfeeding their infant at 6 months of age (Sudbury & District Health Unit, 2013).

Unfortunately, public awareness of community programs to support breastfeeding mothers is low, with less than half (46%) of those surveyed in the area aware of available supports (Sudbury & District Health Unit, 2010).

The SDHU also led two key research projects to gather important information from mothers themselves. Results from the Infant Feeding Study and the Breastfeeding Clinic Evaluation have been used to inform and enhance our programming to better support mothers and their babies.

Rolling out in Spring 2013, the SDHU is partnering with local Best Start Hubs and Our Children, Our Future to pilot NutriSTEP® screening in the City of Greater Sudbury (CGS). NutriSTEP® is valid and reliable multilingual nutrition risk screening program for children 18 months to 5 years of age. Part of a comprehensive healthy weights program for toddlers and preschoolers, NutriSTEP® provides early identification of potential nutrition problems, parental nutrition information, and referral to community resources for primary prevention programming and supports.

The SDHU has also partnered with the Health Sciences North Outpatient Nutrition Counselling program to ensure that our most vulnerable clients will have timely access to additional nutritional support. Post NutriSTEP® screen, all families, regardless of risk score, will have the opportunity to participate in community-based programming focusing on healthy child development and behaviours, with the objective of increasing parental knowledge and skill.

What can SDHU do better when it comes to the recommendations for starting all kids on the path to health?

The SDHU is one of many community partners offering preventative programs and services to support parents and families from the preconception to the prenatal period through to the first five years of a child’s life. However, increased opportunities for parents to access affordable and culturally safe programs and supports are needed. This can be achieved through enhanced community coordination and collaboration among agencies currently offering these services.

The promotion of healthy weights can take place in a variety of settings, but to truly start kids on the path to health, a greater focus on preconception education with young women of childbearing age is essential. The rates of teenage pregnancies in the SDHU service area are higher than the provincial rate, therefore, enhanced collaboration with our local school boards to provide additional education and support in this area is needed to reduce the number of babies born to youth[ii]. Enhanced coordination with other community partners who also provide preconception and prenatal education will help ensure that all young adults are reached in a standardized way. The SDHU is also committed to enhancing our relationships with local clinicians, to align efforts as it relates to healthy childhood growth and development.

Quote from HKP Parent Focus Group

“The stress thing, […] it can affect your well-being, your mental health, and that can affect your parenting.”

Healthy Kids Strategy Part 2: Change the Food Environment – SDHU Grade: C+

2.1 Ban the marketing of high-calorie, low-nutrient foods, beverages and snacks to children under age 12 (SDHU plays a supportive role in achieving the recommendation)

2.2 Ban point-of-sale promotions and displays of high-calorie, low-nutrient foods and beverages in retail settings, beginning with sugar-sweetened beverages (SDHU plays a supportive role in achieving the recommendation)

2.3 Require all restaurants, including fast food outlets and retail grocery stores, to list the calories in each item on their menus and to make this information visible on menu boards (SDHU plays a supportive role in achieving the recommendation)

2.4 Encourage food retailers to adopt transparent, easy-to-understand, standard, objective nutrition rating systems for the products in their stores

2.5 Support the use of Canada’s Food Guide and the nutrition facts panel (SDHU plays a key role in achieving the recommendation)

2.6 Provide incentives for Ontario food growers and producers, food distributors, corporate food retailers, and non-governmental organizations to support community-based food distribution programs (SDHU plays a supportive role in achieving the recommendation)

2.7 Provide incentives for food retailers to develop stores in food deserts

2.8 Establish a universal school nutrition program for all Ontario publicly funded elementary and secondary schools

2.9 Establish a universal school nutrition program for First Nation communities

2.10 Develop a single standard guideline for food and beverages served or sold where children play and learn (SDHU plays a supportive role in achieving the recommendation)

Quote from the HKP Strategy, p.42

“Income inequality threatens health. Income drives many food and physical activity decisions. Families with limited incomes may not be able to afford to buy certain foods or to have their children participate in some physical activities.”

Only 9% of SDHU area residents aged 12 years and older are meeting Canada’s Food Guide recommendations for vegetables and fruit (Ministry of Health and Long-Term Care). Many in our community struggle with meeting the nutritional needs of their families. Five per cent (5%) of households report being food insecure, including homes where children are present (Sudbury & District Health Unit, 2011).

What are the key SDHU actions on the recommendations for changing the food environment?

A great deal of work needs to be done to ensure that everyone in our community has access to healthy affordable food. Making healthy food choices requires more than knowledge about the nutritional value of a food. In fact, the food environment is a key determinant of healthy eating behavior.

Quote from HKP Parent Focus Group

“It is difficult to raise a healthy child in an unsupportive environment. You can do everything ‘right’ at home, but then send your child to child care and they are fed unhealthy foods.”

To improve the local food environment and work toward achieving a healthy food system[iii], the SDHU is collaborating with communities and engaged citizens in the CGS, Manitoulin Island and the LaCloche and Espanola areas. These groups (sometimes called food policy councils) aim to address the many food challenges within our current food system, to create policies and programs that foster healthy communities and to support a strong and vibrant food and farming sector.

The SDHU works together with our many child and youth sector community partners, to create healthy nutrition environments. Children spend at least six hours a day at school or in a child care setting, which makes these environments ideal for teaching and modeling healthy eating behaviours.

Building off the Ministry of Education’s Food and Beverage Policy, the SDHU uses Nutrition Tools for Schools© to help schools bring the policy requirements to life through a comprehensive engagement approach. Students, teachers, parents and the community at large collaborate to make the healthy choice the easy choice, whenever foods are offered or sold.

At Lansdowne Public School, the School Nutrition Action Committee’s student peer leaders promote a monthly healthy eating poster contest for all senior students. The winner of the contest earns a celebratory lunch for their classroom. During the first lunch celebration, a Grade 7 student approached the public health nurse and asked how he could get involved, stating “I would really like to learn how to cook”. This young man will be invited to participate in the next food preparation event.

From the provision of healthy eating information, to training and building capacity of service providers, to the collaborative provision of foods skills programming with vulnerable populations, the SDHU plays a key role and supports our community partners in achieving healthy nutrition environments.

What can SDHU do better when it comes to the recommendations for changing the food environment?

Changing the food environment is a tall order and cannot be achieved by one organization or individual alone. Many publicly-funded venues frequented by children offer foods and beverages contracted through a food service provider. Many of the HKP Strategy recommendations are within federal and/ or provincial jurisdiction, however; ongoing advocacy for changes at the larger food systems level is essential to reinforce changes made locally. None of this can be achieved without strengthened partnerships and supports for community actions to promote health and health equity. To support efforts at the local level, the SDHU will continue to work with our communities to learn more about the local food system, and gather evidence to strengthen our advocacy efforts.

In offering and selling healthier food and beverages in municipally owned and operated facilities, municipal governments support residents to make healthy choices.

The SDHU will make a concerted effort to work more closely with our municipal leaders and other key decision makers so that all environments where children live, learn and play, including recreational centres, are supportive of healthy eating.

Healthy Kids Strategy Part 3: Create Healthy Communities – SDHU Grade: A

3.1 Develop a comprehensive healthy kid’s social marketing program that focuses on healthy eating, active living—including active transportation—mental health and adequate sleep (SDHU plays a key role in achieving the recommendation)

3.2 Join EPODE International and adopt a co-ordinated, community driven approach to developing healthy communities for kids (SDHU plays a key role in achieving the recommendation)

3.3 Make schools hubs for child health and community engagement (SDHU plays a key role in achieving the recommendation)

3.4 Create healthy environments for preschool children (SDHU plays a supportive role in achieving the recommendation)

3.5 Develop the knowledge and skills of key professions to support parents in raising healthy kids (SDHU plays a supportive role in achieving the recommendation)

3.6 Speed the implementation of the Poverty Reduction Strategy

3.7 Continue to implement the Mental Health and Addictions Strategy

3.8 Ensure families have timely access to specialized obesity programs when needed

Quote from KP Strategy, p. 24

“Children’s health does not begin and end with what they eat. Kids live, play and learn in their communities. […] Communities must work together to improve child health. We need a comprehensive all-of-society approach to create healthy communities and reduce or eliminate the broader social and health disparities that affect child health.”

What are the key SDHU actions on the recommendations to create healthy communities?

The SDHU has been very successful in collaborating with a wide range of community partners in efforts to create healthy communities. The SDHU is a strong advocate and leader for achieving health equity: working with key leaders and decision makers so that everyone is able to achieve health and wellness. For example, Sudbury’s Community Door Working Group partnered with the SDHU to conduct an equity-focused health impact assessment of a proposed “shared space concept” within the CGS. Over 50 diverse community stakeholders provided their perspectives on the potential impacts of the shared space model. This helped ensure that the needs of all members of our community were represented and explored.

Alongside partners from the education, social and health sectors, the SDHU is an active member of the Best Start Networks of CGS and Manitoulin-Sudbury District Services Board. Best Start Hub staff, along with the assistance of community partners ensures that families and caregivers are engaged and provided with universally accessible programs, services and resources related to growth and development which are inclusive of healthy eating and physical activity as well as parenting and literacy. When in need, families are provided with information and referrals to help them access screening, assessment and other specialized services in the community.

In the CGS, Sudbury East, and Chapleau areas, SDHU staff work with municipal leaders and community committees to develop and enhance affordable and accessible physical activity and recreational programs and policies. Additionally, SDHU staff advocate for, and increase awareness of the built environment to create healthy environments that foster active lifestyles.

Over the last couple of years, the SDHU partnered with academic researchers to offer professional development to public health staff on ways to prevent weight-related issues, including weight bias[iv]. Training content is based on evidence and aims to shift the attitudes and practice skills of public health practitioners themselves to positively impact their delivery of evidence-informed interventions. Elements of this training are integrated into the education of public health professionals in training, specifically, medical, nursing, dietetic and health promotion students.

What can SDHU do better when it comes to the recommendations to create healthy communities?

We are well on our way to creating healthy communities, but more needs to be done as it relates to healthy weights. Research shows that obese children are at a greater risk of being bullied and experiencing weight bias (Barnes, S. Wellesley Institute, 2012; Yale Rudd Center for Food Policy & Obesity, 2012). There is extensive evidence demonstrating strong links between weight bias and negative consequences to mental health and wellness, and that messaging that focuses on the dangers and problems associated with obesity, can in turn contribute to weight bias (Barnes, S. Wellesley Institute, 2012; Yale Rudd Center for Food Policy & Obesity, 2012; Provincial Health Services Authority, 2013). Utilizing a comprehensive, social marketing approach, families will feel empowered to take a Balanced Approach to healthy eating, active living and wellness.

Quote from Parent Submission, HKP Strategy, p.6

“My son tells me that he didn’t see anything wrong with himself until his first day of school when he saw that he looked different than everyone else. As he went through elementary school, he was mercilessly bullied and he bullied back.”

Now is the time to develop a comprehensive social marketing program to educate, empower and support families in adopting healthy lifestyle behaviours. Our community works well together and the SDHU will continue to leverage these relationships and partner to create communities that promote healthy weights. The SDHU can provide leadership in piloting an EPODE-like healthy weights program in one or more of our communities. Irrespective of a provincial pilot launch, the SDHU will continue to increase awareness and educate families, service providers, and the community at large of the importance of taking a Balanced Approach to healthy eating and active living, in efforts to achieve healthy weights in our community. This includes the provision of Balanced Approach training to community partners who provide services to children.

Moving Forward

Quote from HKP Strategy, p. 38

“To help parents raise healthy kids, we need social change. We need supportive communities that promote and protect health, and help families find balance in their lives.”

The HKP’s Strategy signals an urgent call for action, which will require an all-of-Sudbury and Manitoulin districts-approach to make significant impacts in our communities. The three-part strategy calls for child health to be everyone’s priority and for players within and outside government and for parents, caregivers and youth to take action. We all have a role to play in changing the weight trajectory, and it starts with enhanced coordination and collaboration in all three strategy parts: Start all kids on the path to health; Change the food environment; and Create healthy communities.

The SDHU evaluated its current healthy weights programs and services against the HKP’s 23 recommendations and found that its overall grade is a Bⁱ.

To improve our grade and hold ourselves accountable, the SDHU will regularly report back on our progress. We will continue to engage in a variety of evidence-informed health promotion activities to promote healthy behaviours and environments. To make better programming and policy decisions, we will apply relevant and timely surveillance, evaluation and research results, to monitor both the intended outcomes and unintended consequences.

Just as we assessed our actions against the HKP’s 23 recommendations, we invite others to do the same. We then envision working together to do our best to ensure healthy kids in the Sudbury and Manitoulin districts.

References

Barnes, S. Wellesley Institute. (2012). Reducing Childhood Obesity in Ontario through a Health Equity Lens.

Chen, X. K. (2007). Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. International Journal of Epidemiology, 36(2), 368-373.

Community Action Program for Children/Canadian Prenatal Nutrition Program. (2007). On the move: Mobilizing community and engaging youth to reduce rates of teen pregnancy in Canada. Ottawa, ON: CAPC/CPNC.

Healthy Kids Panel (HKP). (2013). No Time to Wait: The Healthy Kids Strategy.

Ministry of Health and Long-Term Care, P. H. (n.d.). 2005–2010 Canadian Community Health Survey [Data File]. (S. O. Sudbury & District Health Unit, Ed.)

Niday. (2010, December 31). Niday Database Dump. Retrieved February 20, 2012, from Niday Perinatal Database: http://nidaydatabase.com.

Provincial Health Services Authority. (2013). From Weight to Well-Being: Time for a Shift in Paradigms? Technical Report.

Region of Waterloo Public Health. (2007). A Healthy Community Food System Plan. 3.

Sudbury & District Health Unit. (2013). Infant Feeding Study Summary Report. Sudbury, ON: author.

Sudbury & District Health Unit. (2010). Breastfeeding awareness: Benefits of breast milk. Internal Surveillance Report. Sudbury, ON: author.

Sudbury & District Health Unit. (2011). Level of household food security. Internal Surveillance Report. Sudbury, ON: author.

Yale Rudd Center for Food Policy & Obesity. (2012). Weight Bias – A Social Justice Issue: A Policy Brief.

Authors

Lesley Andrade, MHSc, RD, Public Health Nutritionist,
Penny Sutcliffe, MD, MHSc, FRCPC, Medical Officer of Health

For more information on SDHU Healthy Weights programming, please call the Nutrition Physical Activity Action Team at 705.522.9200, ext. 257.

Copyright

Ce document est disponible en français.

[i] Grading Methodology: Grade is based on our assessment of how well the SDHU programs and services align with the HKP Strategy recommendations and the comprehensiveness of our programs and services according to the Ottawa Charter for Health Promotion

[ii] Teenage pregnancy may have health related consequences in the absence of appropriate support systems, health care access and economic means. Pregnant teenagers can be at an increased risk of developing anemia, toxemia, eclampsia, hypertension, pre-term delivery, as well as a prolonged and/or difficult labour (Community Action Program for Children/Canadian Prenatal Nutrition Program., 2007; Chen, 2007). Children born to teenage mothers can also be at an increased risk for low birth weight and other associated health consequences (Chen, 2007).

[iii] A food system is all of the processes which are part of providing food to people. It includes the growing, harvesting, transporting, processing, marketing, selling, consuming, and disposing of food. A healthy community food system is one in which all of the processes involved in the food system are integrated to enhance the environmental, economic, social, and nutritional health of a geographic community (Region of Waterloo Public Health, 2007).

[iv] Weight bias is the negative attitudes, beliefs, and assumptions toward individuals who are overweight or obese. They are stereotypes and judgements that lead to stigma, rejection, prejudice, and discrimination (Yale Rudd Center for Food Policy & Obesity, 2012; Provincial Health Services Authority, 2013).

This item was last modified on July 2, 2024