Canada's Food Guide

Before 2007, the last major revision to Canada's Food Guide was in 1992 - a full 15 years before. Despite the gap, it is not an insignificant government document destined for a dusty book shelf. It has far reaching implications, with schools, hospitals, retirement homes and other institutional settings directly deriving their menus from the it. However, it's methodology and final recommendations have come under heavy criticism for being a product of "big food" and "a recipe for dramatic increases in premature death resulting from chronic diet-related disease."

Given this, how valid is the 2007 version of the Canada Food Guide and what is its utility in practice?


If you have 5 minutes:

Critics have pointed to a number of changes calling into question the guide:

1. Health Canada's Food Guide Advisory Committee included representatives from organization with a vested interest changing the food guide. 25% of parties in the review were from the food industry and included the BC Dairy Council, the Vegetable Oil Industry of Canada, Food and the Food Consumer Products Manufacturers of Canada (representing Cadbury, Pepsi-Cola, Conagra).

2. The food guide is "obesogenic." The fewest calories anyone following the new guide would consume daily is 1700 (females aged 19–50), assuming they only drank water, didn't use salad dressing or have dessert. A middle-aged, sedentary woman of average height would burn about 1500-1900 calories per day.

3. Curious changes have been made to serving sizes. For example, lower consumption of fruits and vegetables (for most categories, a daily intake of 5–8 servings, as opposed to the 5–10 recommended in the 1992 edition) has been recommended, as has more consumption of meat (an intake of 4 servings for men, instead of the 2–3 urged in 1992). The Food Guide also includes a My Food Guide section allowing customization of serving guidelines, that based only on age and gender without taking into account acitivty level, height and other factors, is infact misleading.

4. In June 2010, the 2010 Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans was released. When compared to the 2007 Canadian Food Guide, significant differences are present calling into question the use of evidence based recommendations. For example, the US guidelines suggest increasing the intake of seafood and fat-free/low-fat milk products and consume moderate amounts of lean meats, poultry, and eggs, whole milk, pudding and chocolate milk The Canadian Food Guide does not recommend an increase in the amount of seafood and puts no limits or cautions on meat consumption. It lists in their online guidance.

If you have 15 minutes:

Article in CMAJ

Dr Yoni Freedhoff, a family doctor practicing bariatric medicine has been the guide's most vocal critic and outlines his concerns in the press and in his blog:
Canada's Food Guide to Unhealthy Eating
Big Food Has a Seat
2010 American Dietary Guidelines vs. 2007 Canada's Food Guide
The Bad Joke that is "My Food Guide"

----

The following is Health Canada's explanation of their process and methodology in developing the Canada Food Guide.

If you have 5 minutes:

Health Canada and the Food Guide

In 2004 HC undertook a significant revision of the food guide in a effort to respond to changes in Canadian food habits and to address concerns with the last iteration of the food guide in 1992. This led to a revised food guide in 2006. Criticisms of the old food guide included vague terms such as ‘moderation’, poor representation of ethnic and multicultural foods and a sense that the guide itself had become visually outdated.

In terms of its evidence base HC used a computer modeling processes to determine what food intake patterns ought to be among Canadians of various age and gender groups. Food composites (a measure of various nutrient values) were generated and compared against daily recommended intakes (DRIs) of various nutrients. After a number of attempts, HC arrived at a simulated diet for Canadians in terms of nutrient quantity.

In the second step, HC used surveys that showed what real foods were being eaten by Canadians as a way to test their models and to arrive at how much of actual food should be eaten by people to achieve an appropriately nutritious diet. Essentially, the first step of the process arrived at a diet based on abstract nutrient counts, whereas the second step converted these into actual foods that people might consume. Eventually, by cycling between these two steps, the Food Guide as it stands was developed.

HC describes the strengths of the food guide as ‘flexibility, simplicity, visual appeal, widespread awareness and its consistency with current science’. HC promotes the Food Guide as non prescriptive, reflecting food that is both available in the market and food that is widely consumed already by Canadians.

If you have 15 minutes:

Read the full methods on the Health Canada website

Food for Thought

When we are asked to advise patients on obesity, eating to manage chronic disease and eating at various stages of growth and development, we often cite the Food Guide as a tool that is available to help make healthy food choices.Indeed, allied health professionals may also use the Food Guide to help patients in their healthy lifestyle efforts.However, it is clear that these recommendations are not without a number of challenges and indeed, are not universally accepted.

The question is: should we be recommending the food guide as a tool for patients? If so, which patients are likely to benefit from it? For those patients who are unlikely to benefit, what alternatives do we have to offer them, and are we prepared to spend scant available resources to provide appropriate education?

Redefining Health

Three stories of the social determinants of health and a social medicine approach. Produced by the Community Health Promotion Network Atlantic, based in St. John's, Newfoundland.

http://www.changingourpictureofhealth.ca/
http://www.chpna.ca

Redefine. Rebuild. Reconnect: Changing our picture of health from Population Health Working Group on Vimeo.

The Right to Health

Munk Does Healthcare

Hi everyone! Thanks for great turnout at our first Queen's Social Medicine meeting on Essential Medicine. Hopefully the next topic will invite just as much lively discussion.

In 2004, Canadians voted Tommy Douglas, father of medicare, as our 'Greatest Canadian.' Beating out the likes of Wayne Gretzky and Pierre Trudeau, this was not only a testament to the stature of Douglas, but also showed the value we place on our health system and has surrounded the debate on how to move reform forward.

Many reformers have looked outside our own borders to draw lessons for change at home. Our closest neighbour has garnered much of that attention and was the focus of the 5th bi-annual Munk Debate (June 2010).

Debating the resolution "Be it resolved I would rather get sick in the United States than in Canada" were physician leaders from both countries. On the PRO side was Bill Frist (former US Senate leader and surgeon) and David Gratzer (Canadian psychiatrist with a cross-border practice). On the CON position was Howard Dean (former Governor of Vermont, US presdentital candidate and family physician) and Bob Bell (CEO of UHN and surgeon).

If you have 15 minutes:

Check out this excellent summary from Steve Paikan of TVO's public affairs program 'The Agenda.'

If you have 60 minutes or more:

CBC Idea's has a 53 minute abridged version of the debate available here. If you're a fan of podcasts, it's also available through iTunes.

If you'd like to see the entire debate uncut and in video, you can watch it from the Munk Debates website.

Make sure to use the following log-in information:
Username: queenssocialmedicine@gmail.com
Password: Virchow123

Keep this in mind as you wait for the video to load.

If your curious about the choice of password, this should help.

Essential Medicines, Poverty and Profit

When it comes to treating diseases of the developing world, many doctors rely on tests or drugs that are either antiquated, ill-adapted or ineffective....that is, if they exist at all. The current method of financing health product development is often cited as a major barrier to the development of new, cheaper and more effective treatments. That 90% of the world’s spending on health research is still spent on the health problems affecting less than 10% of the world’s population is often cited. MSF (Doctors Without Borders) highlights this problem of medical innovation and other challenges in their Access to Essential Medicines campaign.

If you have 5 minutes:

They highlight a number of reasons why health financing has stunted medical innovation:

1. Global spending on health research is skewed towards wealthy markets. Global spending on medical innovation has increased dramatically from US$ 30 billion in 1986 to US$ 105.9 billion today. A closer look shows how 90% of this money is spent on the health problems of less than 10% of the world’s population.

2. Diseases that take the heaviest toll do not attract the most investment into R&D. Between 1975 and 2004, 1,556 new chemical entities were marketed globally. Only 20 of these – a mere 1.3 per cent – were for tropical diseases and tuberculosis, which account for 12 per cent of the total disease burden.

3. Medical innovation is steered towards drugs that give commercial rewards, not the greatest therapeutic benefits. Pharmaceutical companies have more interest in developing a drug that will be lucrative, even if it doesn’t improve on medications that already exist rather than one that may represent a greater therapeutic breakthrough but for which there is no commercial market.

4. Funding for medical innovation that addresses diseases of the poor remains grossly insufficient. Governments are lagging behind philanthropic organisations such as the Bill & Melinda Gates Foundation, or even Médecins Sans Frontières . A recent report by the Treatment Action Group estimates at US$ 800 million the annual shortfall into funding for TB R&D.

5. This happens because in today’s R&D system, investments into R&D are paid for by charging higher prices for medicines. R&D relies on companies recouping their R&D investments through charging high prices, and protecting that price through patent monopolies. Not only does this mean that some drugs remain completely out of reach for many patients, it also means that diseases like TB or paediatric HIV that mostly affect the poor don’t get anywhere near the attention and investment into research as diseases that have bigger, more lucrative markets.

MSF also goes on to propose a number of alternative models:
1. Product Development Partnerships
2. Prize Model
3. R&D Treaty
4. Working with industry

If you have 15 minutes or more, check out the following sections of the MSF campaign:

- Introduction
- Current Challenges
- What is wrong with R&D today
- Looking for alternative models

----

The following reading is another perspective on the 10/90 Gap. It's an interesting take, and stands in contrast to the MSF activist perspective on access to essential medicines.

If you have 5 minutes:

The author argues that the 10/90 gap is a misleading claim by activists. He suggests that the idea that 90% of the global pharmaceutical research budget is spent on diseases affecting only 10% of the world's population is false. He makes a number of arguments in defense of his thesis

1. Neglected Diseases represent a small percentage of mortality in the developing world. Tropical diseases that are widely touted as neglected often have preventive treatment or cures. He names only three tropical diseases that are truly neglected, according to the WHO.

2. Poverty is the real cause of disease. Diseases associated with poverty (such as TB, malaria, HIV/AIDS, treatable childhood illnesses and malnutrition) represent much more of the disease burden so called 'neglected' diseases. In addition, they are preventable.

3. Illness in low income countries is converging with high income country disease profiles. Conditions such as cancer, mental illness, and cardiovascular disease are more than 60% of the disease burden. Obesity is on the rise in the developing world. When research is done on these conditions, poor countries benefit.

The real issue, he argues, is access. The world's poor have limited access to treatments that are available for their health conditions. He posits that there are a number of issues that lead to poor access among the poor, and IP rights are not the most significant issues.

1. Intellectual property is not as big an issue as activists would have you believe. Most medicines on the 319 item list of the WHO essential medicines are not patented in the 65 poorest countries in the world.

2. In country taxes and tariffs can increase drug costs significantly. For example, in India duties add 55% to drug costs at the consumer level. Value Added Tax is another mechanism countries have of increasing revenue by up to 12%.

3. The way to increase access is to increase wealth. When people are better off, they can afford treatments, physicians and other health care workers can are more likely to stay in the country and deliver services.

If you have 15 minutes or more, check out the following sections of the full article: Diseases of Poverty and the 10/90 Gap

- Introduction
- Neglected diseases are a tiny fraction of total mortality
- Most Disease in lower income countries is caused by poverty
- Illness in high income countries and low income countries is converging
- Access is the real problem - not innovation
- Intellectual Property rights
- Taxes and Tariffs
- Table 3
- Wealth creation as a means to improve health



Article Details:
MSF Campaign for Access to Essential Medicines. What is Medical Innovation? Accessed July 2010.
Stevens, Phillip. Diseases of Poverty and the 10/90 Gap. November 2004.