EVIDENCE

[Recorded by Electronic Apparatus]

Thursday, May 9, 1996

.0859

[English]

The Chair: Good morning, everyone. It's 9 a.m., and we do have a quorum. In a subcommittee instance, you need fewer people around the table, as long as we have two parties, which we do here this morning.

I welcome Simone and John Joanisse to the table.

Pursuant to Standing Order 108(1), a study of Bill C-222, warning on alcoholic beverage containers, is why we're here. This is the private member's bill of my colleague Paul Szabo.

I know you have a written presentation here. We try to keep verbal presentations to 5 to7 minutes, just to summarize that. At the same time, it allows us lots of time to ask questions. So please go ahead.

.0900

Dr. John Joanisse (Individual Presentation): Thank you, Madam Chairman and members of the committee, for allowing us to appear before you today.

It's not without some trepidation that we appear here before you. We fear that if in some way our presentation is found wanting, perhaps there will be some detraction from the importance of this message.

In any case, to introduce ourselves, we are a long-time political assistant to federal members of Parliament - perhaps ``a party hack'' would be more appropriate - and a medical doctor who practises family medicine and is currently the chief of staff at a local general hospital.

As the parents of three healthy children, we chose to share our good fortune with several special-needs children, three of whom we've adopted. The third of these came to us in 1986 with a diagnosis of fetal alcohol syndrome. It is because of her that we have chosen to dedicate our expertise and energy to the prevention of fetal alcohol syndrome. We've deposited with the clerk a brief that tells a bit about what it is like to live with an FAS. We urge you to read it and the new articles we bring today and to ask any questions you may have. However, we will summarize our points quickly.

Why are we here today? We want to talk to you about responsibility - responsibility in fetal alcohol syndrome.

Science - that is, research - has a responsibility. The responsibility was to observe congenital defects and to investigate their causes, and the researchers' conclusions are that links between FAS and fetal alcohol effects, FAE, are indisputable. The effects are physical, neurological, behavioural, and emotional.

The hard wiring in the fetal brain's computer is deficient. The incidence is 1 in 600 to 1 in 1,000 and is thought to be underreported. The condition is the commonest of all congenital birth defects. There is no cure. There is no drug to make it go away.

Today in the media we learned that the father of a child affected by a devastating inherited metabolic condition is lecturing here in Ottawa on the need to pursue a new cure for this problem - a new Lorenzo's oil. You perhaps saw that touching movie. The comparison with FAS is more one of contrasts.

FAS has no gross, obvious physical defects. What you see on a child is rather minor. The effects are not on the covering or the sheathing of nerves, but with the very number of neurons and their connections.

No cure is sought. We have prevention. Yes, it's entirely preventable.

The final scientific fact is an important one. There is no known safe level of exposure, though in truth the scientific studies referred to one and a half to two ounces of intake at a time.

Nevertheless, the conclusion of the Surgeon General of the U.S. several years ago was that the introduction of labelling was important as it was likely that there was in fact a dose response curve below the level mentioned above.

Therefore, the research is exhaustive, the science is objective, the links are solid.

Responsibilities? The beverage industry has responsibilities, those of any manufacturer of any drug, to provide proper labelling for a drug with known toxic and teratogenic effects. No other drug on the market is so widely distributed, yet this one is available with no mention of counter-indications, such as possible pregnancy, on its containers. To place a product on the market is a contract with the consumer. This is an obvious responsibility.

Do we really want to expose our population to caveat emptor when that which is at risk is a potential mother, and what is at risk in the bargain, in this deal of caveat emptor, is in fact the life-long effects on an innocent unborn child?

Is the industry fighting this legislation because of the cost of labelling? I think not. It is rather that it fears the effects of a warning label that might give pause to every female of child-bearing age to consider whether she might be pregnant before taking a drink. The emphasis is on ``a drink''.

There is a loss of market share at risk here. There is further doubt cast on this drug which is alcohol.

The alcoholic beverage industry have rejected the responsibility. They are not good corporate citizens. They would have us believe, even though they themselves have admitted to the standing committee in the previous government that the labelling is easy to implement.... They are threatening the withdrawal of the pitifully small amount they now spend on education in a last-ditch defence of their immoral position.

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Where is government's responsibility? Government, through Health Canada, has major duties to its constituents to ensure the proper, safe, informative labelling of all drugs to protect the public from the hint - the hint - of a problem from a product. One need but remember the thalidomide catastrophe to realize the importance of the health protection branch.

To spend wisely - regulation? A single regulation versus the loss of productive lifetimes - 1 in 600 births. It's $10 million versus $2.7 billion annually on FAS. There's no need to be the Auditor General to figure this one out.

Finally, one can only imagine the legal exposure of Health Canada's sidling up to the bar with the beverage industry should a class action suit be launched by the well-informed FAS network.

What about the medical community? The medical community has taken up some responsibilities. The CMA has come out firmly in support of Bill C-222 in their brief to this committee. The Canadian Nurses Association continues to advance the cause of prevention and the positive effects of labelling, coupled with increased public awareness. We have brought you a few of their articles today.

As chief of staff, I'm aware the area hospitals are attempting to become ``baby friendly'' as defined by the World Health Organization. This requires universal breastfeeding by all mothers and a number of other important measures to secure the newborn's environment.

The fetal alcohol baby can't even suck properly on breast or bottle. The situation is ridiculous. The paradox is glaring. Our obstetricians spend a great deal of time seeking out early pregnancy problems. They may often be too late to do anything about this particular problem, even though they may see the pregnant patient very early in their pregnancy; that is, as soon as the pregnancy test turns positive. The opportunity for prevention has already been lost by then and a productive life is destined to be curtailed.

The solution is multifaceted and labelling is only one small piece of the solution. Nevertheless, it cannot be ignored. The opportunity to prevent only a minority of cases cannot be tossed away because it is not the magic bullet. There are few magic bullets in medicine.

In contrast to the industry, there are those who are not afraid to take on their responsibility. This committee, through its chair and the MP who proposed Bill C-222, has done so. By holding committee meetings it can look back to work done by the previous committee in 1992, which considered FAS, and act on its recommendations, which were clearly stated at that time. It can hear all presentations, even from ordinary people like us; in fact, especially from those who are not motivated by financial self-interest. It can seriously reflect on what is best for Canadians, not necessarily what is best for one industry.

[Translation]

Why are we here? Because the responsibility for living with these children rests with us, the parents. Who could be in a better position to explain to you the human aspect of this tragedy that could undoubtedly have been prevented?

Earlier this year, following the introduction of this bill, my wife and I wrote to all members of Parliament informing them of the very grave problem of foetal alcohol syndrome. We received letters of support from members from all parties, and we thank you for that. It was very encouraging.

In her most recent letter, the Parliamentary Secretary to the Minister of Health at the time,Ms Marleau, indicated her full support for this bill and for our undertaking. Imagine our surprise when we recently read in the Citizen that the current minister had some hesitations about the very same bill. Why this sudden change of heart.

[English]

The change in position is certainly not based on new science. It's not because of the medical community. It's certainly not because of the affected children or their parents. So what has happened? You tell me.

If this bill doesn't pass, I'm offended as a taxpayer and a voter, as a physician and an administrator, and more importantly as a parent and a human being.

Thank you for listening.

The Chair: Thank you, Dr. Joanisse. Very compelling arguments for.

[Translation]

Ms Picard.

Ms Picard (Drummond): Madam Chair, I have no questions for the moment.

.0910

[English]

The Chair: John.

Mr. Murphy (Annapolis Valley - Hants): Thank you for your presentation. It was a passionate, articulate, intellectual presentation, and I appreciate it.

I have no argument with what you are saying about fetal alcohol syndrome. That's not where I'm coming from on this whole issue. I guess my only interest is in what you said, that this is a multifaceted intervention that needs to be made. I couldn't agree more. I see it as a responsibility of Health Canada, among others.

I still come back to whether labelling would make any difference. The reason I say that is that I hear from the research.... It depends on who presents the research to you, of course.

Ms Simone Joanisse (Individual Presentation): You remember that comment.

Mr. Murphy: Yes, indeed I do.

I guess I would ask this question of you: can you help me to understand better?

Ms Joanisse: We're obviously very involved in this -

Mr. Murphy: Of course.

Ms Joanisse: - and we live with it every day. That's number two. The stuff we've read over the period of time we've chosen to take prevention as our cause, if you want.... There is research.

I'm not Earnscliffe. I'm not the lobby group that came and talked and did the research for the beverage industry. We're our own lobbyists. The stuff we're reading...I don't know about it empirically, but it says there was a modest change in the United States whenever the labelling came in. ``Modest'' is still a good word, because if you have one less fetal alcohol kid, believe me, you've saved yourself some bucks, number one. You've given a life some potential, number two.

So let's go back to labelling. What's on the American bottle is too small. I think we know that. We saw that. Maybe it's too wordy. We know that. I heard Mr. Hill when he spoke in the House at first reading, and yes, perhaps it should be more graphic. I don't know.

Labelling is a culture. It's like when we talked about gun control. First of all, we said it's the right thing to do, and second, maybe tomorrow somebody won't come in and shoot somebody in my home. Within decades it'll be our culture that we're a peace-loving, non-shotgun-holding community. It's the same thing with this. You'll bring it in gradually. It'll spark people to think about it.

The beverage lobby said 95% - it went up several times during their conversation and on TV it went up to 98% - of people know it's wrong to drink when you're pregnant. I went back and talked to my colleagues and your staff, who we think are pretty smart, and asked them. I didn't get one of them who could tell me why you can't drink when you're pregnant. It's not a good idea, they said. But why? They didn't know the effect of alcohol, and these are educated people.

So I can't say enough about labelling being the beginning of a big task you have. I know. But couple it with some public education.

And it's going to happen. We saw it when we visited a son of ours in California. It's on the bottles in the States, as you know. But in the bars, there's a sign over the bar, and it's big: ``Don't drink when you're pregnant''. You go to the bathroom and it's on the stalls: ``Don't drink when you're pregnant''. So it'll come.

But come and live with an FAS kid and see if it's not important.

.0915

Mr. Murphy: You don't need to convince me in that area at all.

What other interventions would you see as being paramount for this problem, other health interventions that need to be made?

Ms Joanisse: Whenever I drive home at night I go past a billboard that has a brain on it. It says ``Your driving companion''. It's part of the $10 million the industry spends. Wonderful. But I've never seen a billboard that size on my way home that says ``The hangover that lasts a lifetime'', with a fetal alcohol kid there.

They have put money into FAS, I know. I know there's money with the Canadian Centre on Substance Abuse. But I don't think you know they have a volunteer staffing that line one afternoon a week.

They have put money into FAS, there's no doubt. But there has to be more, and I think the labelling is just the start. If you start labelling things, you'll wake up the beverage industry to better responsibility, you'll wake up the public, you'll wake up the bar owners, you'll wake up all of us to this tragedy.

Mr. Murphy: So would you see us putting more warning signs in bars?

Ms Joanisse: Yes, but not without the labelling. I'm not going to tell you to forget the labelling and put up a warning sign. It has to be a good-sized, graphic label.

Dr. Joanisse: Speaking for my profession, we need education. There's no question about it, but that doesn't exclude labelling. We need it in medical school, and I'll tell you that this is what we're going to start doing. I have obstetricians and pediatricians in my hospital who still figure that alcohol abuse causes FAS. Sure it does, but what about the other end? What is abuse? Well, abuse is one drink.

Finally, I can't believe that the alcohol lobby is missing this opportunity to score some points. It's a cheapie, yet, as I said in my presentation, it can't be the cost of labelling. They must be afraid of the effect on the culture.

Mr. Murphy: I understand too clearly, because I come from a background of mental health and psychiatry, in which we see lots of these kids. Most of the time, you didn't know what it was.

Ms Joanisse: That's right. That's another point, though.

Mr. Murphy: You're doing managed behaviour stuff... it's unbelievable. There's no arguing with me on this. I'm still just back to whether or not it is going to bring us some results. Or do we need to put some interventions in other places - education, of course - throughout the system?

Anyway, thank you.

The Chair: Thank you, Mr. Murphy.

Mr. Szabo, it's your bill.

Mr. Szabo (Mississauga South): When they were before us, the industry did say there was a 95% awareness level. When asked by the Standing Committee on Health about the FAS incidence that came before them - how many of those women knew of FAS - the answer from the National Crime Prevention Council, as I recall, was that very few did. So the validity of the representations seems to be something that we have to look at, Madam Chair.

I hope you'll be able to help us, because I think the big issue here has to do with what my honourable friend here has raised, and that really is the question of effectiveness. There's no point in doing legislation if there's no reasonable expectation that it can make a positive contribution.

I have something here, Madam Chair, and I would like to circulate it or give it to the clerk to make copies. It's from the National Institute on Alcohol Abuse and Alcoholism, and I'd like the doctor to comment on it. I'll just paraphrase what it says.

Six months after the labels were implemented, 21% of American adults were aware of the label, while eighteen months after implementation, 27% were aware of the label. The highest rates of seeing the labels were among groups most targeted for receiving the warning label messages because of certain risks, i.e. young women and heavy drinkers. It concludes that respondents who saw the label were significantly more likely to report not driving because of drinking, and not drinking because of driving. And those are just some of the things.

The issue here is what constitutes effectiveness. Is it awareness, is it change of behaviour? As a doctor, John, can you give us an idea of whether or not you believe the U.S. experience, which I think is the most relevant, has even seen enough time pass? Given that the data all seems to be 1992-93 data, has there been enough time for anyone to conclude anything about behavioural change as opposed to just increased awareness levels?

Dr. Joanisse: I don't think there is much doubt about it. I'm not a researcher, I'm not a statistician, but I can tell you that in my experience, when pregnant women have come to me, they've said they have seen this thing on the cigarette package that says it's not good to smoke during pregnancy, and they ask me if that is true. So that's the sort of question that we will get, and it will be triggered by the labelling. They will come for more information.

I think what we are aiming at, as I said earlier, is not the abusers. I'm not saying they're irrecoverable, but I don't think the label is going to affect them. What we're aiming at is that innocent person, that person who's just not knowledgeable. That person does exist, and we want to trigger a hesitation in her. We would like her to think twice before drinking. If she thinks twice, she may not drink at that point. She may come to seek more information, and if the information is available, that's great. And if the alcohol industry, Health Canada and the CMA want to pitch in and provide more information, that's A-1, that's great. But we just have to give that innocent female pause.

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Mr. Szabo: I have one last brief question. As a physician or maybe as a parent of an FAS child and with your involvement with the issue of FAS, what would be your estimate of the number of women who would be aware of either FAS or the consequences of consumption during pregnancy?

Ms Joanisse: I'll talk to that first. As I said, I went back from listening to the beverage lobby and reading this report and did my own informal survey. I've been doing it a lot more in getting ready for today; I asked some young pregnant women who are friends of our older children and I asked people I work with, and they don't know. They know our daughter and they know she has all of those problems. She's kind of cute and we bring her everywhere, and that's all they know.

They don't know about FAS; they don't know that it could have happened to her mother because she might have had one drink a day for the first three months she was pregnant or two drinks a day for six months or one drink a day for nine months or she might have been drunk once. They don't know.

I think the more we can wake people up to it and get them talking about it, like you're doing, and the more we can encourage that through getting people from the industry to come on-side, the better it is and the more people will understand the whole issue. It extends to drinking and driving and to abusing alcohol and all that. With our issue, FAS, we're looking more at the moderate drinker or at those who are drinking, period, while they're pregnant.

The Chair: Dr. Hill.

Mr. Hill (Macleod): You said something that struck my mind. Of course, my favourite label is a graphic label, a simple label that shows a pregnant woman in profile with an X across it. Does that mean more than a label that is difficult to read and may not be read?

Ms Joanisse: I saw one of your colleagues here taking those American bottles and looking at them under a microscope. Yes, there will be people who won't go that close to it. I heard you when you spoke the first time in the House, and I like that idea of the graphic, a very obvious thing. We know that we look at smoking like that, plus it's multilingual as well. I'd also like it to be very large, though; I want it to be prominent. I don't want it to be hidden in the bottom right-hand corner. You're going to have to be able to see it. As an occasional drinker, I like it.

Mr. Hill: Dr. Joanisse, we've talked many times about a voluntary compliance by the beverage industry. Our association, the Canadian Medical Association, speaks strongly to this. I think our association misses an opportunity here to join with the beverage industry and provide some funds for a label. I think the health organizations could well become involved in a joint program, and I would like to know what you think of that.

Dr. Joanisse: I agree. I think they should certainly work hand in hand, but I think we have an unwilling partner at this point.

The Chair: Mr. Scott.

Mr. Scott (Fredericton - York - Sunbury): I have something further to that. I also participated in the healthy children meeting with Claudette Bradshaw from Moncton,New Brunswick at the head start program, and I think she made an important point. This is very difficult because everyone is on the same side; it's just a matter of detail, in my mind. She identified; she has an at-risk kid program in Moncton.

The point she made was that many of the people she deals with aren't the people these labels would most affect. She makes the point that the parents of a lot of the kids don't read. This speaks to what Grant has said.

The other point is that if it is a targeted group and if there's a particularly vulnerable community that we need to get to, is this the best way, or are we sending the message too broadly? That's my question. That's what I'm getting to, and if there's any research I'd be interested.

.0925

Ms Joanisse: I know the industry says that as well, Mr. Scott, that you're not going to hit the woman who's drinking.

The issue talks to poverty too. It's my understanding that especially in large communities most of the drinking seats, as they say when they license places, are in the poor areas. If you look at Vancouver there are statistics on that, and I've read about it in Toronto and Montreal. That's where you have the predominance of alcoholic beverage places, pubs and bars and stuff like that where you can drink.

That's where a lot of the people are going; they're going to these bars and whatever. People say that as soon as they open the bottle they don't see the bottle, but the person opening the bottle sees the pregnant woman, if it's obvious that she's showing, and the people who serve and the people who are around her see her, so you're talking about a culture. I think that's what we're looking at. It won't happen tomorrow and it won't happen for that person who has already given birth.

Mr. Scott: The question isn't so much about the effectiveness of labelling, to be honest. I've spent enough time on the tobacco issue that I'm convinced of the effects of labelling. In this case it's more a question of whether the group of people we're trying to get to isn't more narrow. Is this the best way to get to that particularly narrow group?

Ms Joanisse: You'll get to them eventually. FAS can happen to me and it can happen to any woman of childbearing age. It doesn't have to be the person at risk.

Dr. Joanisse: Does it have to be the best way to be useful?

Mr. Scott: No, but it is a way. We have to make some choices.

The Chair: Madame Picard.

[Translation]

Ms Picard: Ms Joanisse, I would like to know whether some women run more risks than others. According to my understanding and what witnesses have told us about foetal alcohol syndrome, when you drink one glass of wine a day, as is the case in some cultures, you run the risk of giving birth to a child who develops these kinds of problems.

What happens in the case of women who don't yet know they're pregnant? In my culture, in my family, we drink wine with our meals. When I became pregnant, I only found out after three and half months, and in the other case, after four months. And yet, both my daughters are perfectly normal and have no problems of this kind.

I would like to know whether alcohol abuse leads to this kind of risk or whether we are all at risk.

Dr. Joanisse: It is not limited to abuse. There's a direct relationship between the quantity consumed and the effect: the graph is in a straight line, in response to the dose. The question that arises is precisely the one you've asked: why is it that some women who consumed a very low quantity of alcohol perfectly innocently carry children that are perfectly normal? We don't know.

At that level, the problem is certainly multidimensional. There may be some genetic predisposition - though I'm going well beyond my expertise here. One foetus undoubtedly runs more risk than another foetus exposed to the same quantity of alcohol. That's what we're observing in many cases. The manifestation of the syndrome depends on many factors. Therefore, what's completely inoffensive in your case may be harmful in another, for reasons that we just don't fully understand right now. But the risk does exist. I'm very happy to hear that your children are well; that's also the case of our children. I must admit that our three biological children are old enough now that I don't remember whether my wife consumed a bit of alcohol during her pregnancies.

Ms Picard: We're also referring to several different cultures, including the French culture. I have many women friends who are from France. They are healthy and so are their children. And yet, as we all know, this is part of the broader culture in France. Even children drink a glass of wine with their meals, just as ours drink a glass of milk. I can't understand this.

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Couldn't alcoholic men father children with these kinds of problems? Could a father's alcoholism also be a problem for the foetus?

Dr. Joanisse: It seems not. The toxic effect of the drug is transmitted and harms the development of the foetus as of the second week of gestation. There doesn't seem to be any change in the sperm, or in the genetic aspect of the chromosome itself. Everything happens at that later stage, when the child is in the womb.

Ms Picard: Thank you very much.

Dr. Joanisse: With regard to culture, the studies we have seen were conducted mainly and perhaps exclusively in North America, particularly in the area of Seattle. I don't think that scientists in France or elsewhere in Europe have addressed the issue. Perhaps I'm venturing into something on which I should not express an opinion.

Is it because there's a seat belt law in our country... You know the argument.

Ms Picard: Yes, yes.

Dr. Joanisse: Thank you for your question.

[English]

The Chair: Before we wrap up with you, Dr. Joanisse and Simone, you mentioned the comments of the Minister of Health. It's unfortunate the minister responded before we had heard all the witnesses, but in fairness to the minister, I think Mr. Murphy put him on the spot by asking what his opinion on that was. Now we're faced with the issue of convincing the minister the bill is worth supporting.

This is the last day of witnesses. We will be coming back with clause-by-clause on Tuesday. I think what would help Nancy is.... We've heard fetal alcohol syndrome causes birth defects and it causes behavioural and learning problems, but do you know if government bodies in Canada collect national and provincial data on the problems of either of these alcohol-related conditions? Has any effort been made to cost-estimate this?

Ms Joanisse: I worked a little with the Fetal Alcohol Support Network out of Toronto. You're going to hear from Health Canada later. A health official from Health Canada was at a conference I went to. She showed us some research, a policy they were drafting with the CMA, with the Canadian Nurses Association, and with the association of paediatricians, where they were talking about incidence - I think that's what you're asking about - and that's where the 1 in 500, 1 in 600, was debated. They think it's underreported at 1 in 600. They think it's more 1 in 500. That's what I was told then.

Also, in the policy they were debating - I've been trying to get it from the legislative assistant to the minister, but we haven't been able to connect. The policy they were trying to draft at that time, in February of this year, stated very clearly the input of these people, these organizations, and Health Canada's research...that there was no known safe level of alcohol consumption during pregnancy. Those words were very important. That came from their research on the incidence and the time at which the alcohol affects the fetus.

One of the things we've left is a chart I picked up there. It says at how many weeks it affects the brain, at how many weeks it affects the ears, at how many weeks it affects the limbs, and things such as that. So you might look at that. But again, we're our own lobby firm here.

The Chair: Thank you very much. You're doing a tremendous job of being your own lobby firm. We really appreciate your coming before us. You've given us some very compelling evidence. All I can say is thank you, Doctor, for taking time out of your busy schedule at the Montfort Hospital and dashing over here this morning. Simone, thank you.

Dr. Joanisse: Thank you for listening.

The Chair: Thanks a lot. Good luck.

.0935

Our next witnesses are from MADD Canada.

Good morning, Mr. Bates and Ms Meldrum. Thank you for appearing before this committee. Mr. Bates, I understand that you're the founder and the national director.

Mr. John Bates (Founder and Director of the National Board, Mothers Against Drunk Driving): That's correct.

The Chair: Ms Meldrum, I understand that you're a victim.

Ms Jane Meldrum (President of the National Board, Mothers Against Drunk Driving): I'm the president at the moment.

The Chair: Okay, sorry. You have a presentation to make. We'd be pleased to hear it. Could you try to make it in five to seven minutes, if possible? Thank you.

Ms Meldrum: I'll be very brief.

Thank you, Madam Chairman and committee members, for having us here this morning and giving us the privilege of supporting Bill C-222.

In three days' time, May 16, it will be the sixth anniversary of the day that the world as our family knew it ended. Our only son unsuspectingly got into his car to drive to work, not knowing that there was a killer - known as a drunk driver - on the road that night and that he would become his victim.

Friends of ours adopted a baby boy over twenty years ago, and as he grew their home became a hell on earth. The reason? He had fetal alcohol syndrome. We must all remember the horror of the drug thalidomide, which stopped the development of fetus's limbs. That drug was promptly withdrawn.

The drug alcohol stops the development stages of a fetus's brain, and yet we are in a battle to put a warning label on this drug. Would that the answer to alcohol was as simple as the answer to thalidomide.

We have warning labels on tobacco products and have smoke-free areas, yet no one who smokes tobacco kills or maims innocent human beings in criminal acts from that indulgence. We have no protection from the consumer of alcohol and all the many crimes that flow from alcohol consumption.

I know that a warning label on this product will not in itself be the answer to the tremendous problems that alcohol causes, but I believe it is one step towards trying to solve this problem. MADD therefore fully supports Bill C-222 and asks that this be viewed not as a political issue, but as a human one.

Thank you, Madam Chair.

The Chair: Thank you, Ms Meldrum.

Mr. Bates, do you have something to add to that?

Mr. Bates: Yes, Madam Chair. I submitted a brief to the committee and I understand it has been distributed, so I will not even attempt to go through the whole thing. I will merely touch on some of the highlights.

This organization was formed as PRIDE - People to Reduce Impaired Driving Everywhere - some fifteen years ago. One of the very first planks in the very first platform we submitted was alcohol labelling. We consider it to be that important and that central to the solution of the problem.

Let's all stop kidding ourselves here. Alcohol is a drug. It's as much a drug as is cocaine or heroin or any other so-called illicit drug. Its status is such that it's listed in the pharmacopoeia as an addictive, mind-altering substance, so let's stop fooling around here. The fact that alcohol is a licit or legal drug does not in any way change its status as a dangerous drug.

.0940

In fact, the social damage caused by alcohol outweighs that caused by all illicit drugs combined. It's estimated that we lose something like 500 people to illicit drugs every year. We lose19,000 people to alcohol-related causes in a year. For example, some 1,500 people die, as Jane's son did, because of impaired driving in automobile crashes; and 65% of snowmobile deaths, 50% of all violent crime.... I won't go into the full problem with alcohol, because, in my view, the honourable Paul Szabo eloquently and completely outlined the problem we face in his statement to the House on December 7, 1995, when he introduced Bill C-222.

But we still remain mystified, and I think everybody else is, and I think the public is demanding an answer. We certainly are. Why is alcohol the only consumable substance that for some reason is exempt from the labelling laws? Why?

I think the House has to answer that question. The politicians are responsible for answering that question. We want to know why. Even a can of soup is not exempt from the labelling laws. But with the mortality, the morbidity and the misery caused by alcohol, does it make any sense at all to refuse to give Canadians all the information at the point of consumption and sale? Does it? Of course it doesn't. It's ridiculous.

Let's get into the industry. The industry's objections to this, as was pointed out so well before, really appear to lie in just three areas. They think labels would be expensive, and they won't be. They say labels won't work anyway, and they will. They say labels will scare people, and that's a good idea.

Then we get into this business of whether it's effective or not. It's clearly up to the industry to prove labels are not effective rather than having the health and safety people prove they are. That only makes sense.

Almost every dangerous product in society has a warning label; you name it. Power lawnmowers even have a label that says you're not to put your hand under there when the lawnmower's running. Well, nobody's going to put their hand under there when the lawnmower is running anyway, so why do they put it there if it isn't effective? They probably put it there for reasons of lawsuits and so forth, but obviously it's effective. That's why they put it there in the first place. All of them do.

It should be a matter of plain common sense. Our most dangerous drug, one that's freely available, should be universally known as a drug. And the reason it's not known and accepted as a drug is because of the most powerful lobby in Canada today, the alcohol lobby.

Now, if the members of this committee have not yet been subjected to the lobby, you soon will be, as will all of your colleagues in the House. I've been fighting that lobby now for the last fifteen years and I understand their power. They have money. Needless to say, we go into these hearings with a straw hat and a cane, and they go in with their colour brochures and so forth.

Why do they fear this particular legislation? Why are they turning handsprings about this thing? They've pulled out all the stops. Why? There is only one reason. Believe me, it's not cost. It's because this is going to affect sales and consumption. That's the reason they don't want the labels. The reason they don't want the labels is exactly the reason why we do: it will lower consumption, lower abuse and lower the incidence of impaired driving.

They've been selling alcohol freely, as a normal run-of-the-mill thing people do every day. Molson's has their famous ``take care'' campaign for responsible use, yet the same company that has a ``take care'' campaign has commercials of kids tearing down a mountainside on mountain bikes and then getting to a cliff and climbing down a cliff carrying their bikes. That's the kind of thing their beer drinkers do.

Another one from the same company has kids running along and jumping off a 1,000-foot cliff with parachutes, and they have the unmitigated gall to come out with another campaign saying ``take care''. They get away with murder on this kind of stuff.

What if we said, okay, you can put health labels on here? There are some studies that tend to show that cardiovascular disease can be lessened with two drinks a day. If the government allowed that, do we think for one instant that we'd hear any of the objections from the industry about why labels shouldn't be put on bottles? They'd be falling all over themselves to put them on. Of course they would.

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Let's get back to this health thing they're talking about. Does it make any sense at all to consider alcohol...? Here's the wine industry in the States petitioning the American government to put health labels on their wine. There are all kinds of things the doctors and medical people in this room will tell us do exactly the same thing as the so-called ingredient in red wine does. Vitamin E, ASA or acetylsalicylic acid, a healthy lifestyle, low fat: there are a lot of better ways of reducing cardiovascular diseases than alcohol.

The Chair: Mr. Bates, you're at nine minutes. I'm wondering if you could wrap up so we could have some questions, please.

Mr. Bates: I have a bunch of other things that do have labels on them.

The Chair: It will probably come out during the questions and answers. That might be more appropriate.

Mr. Bates: I'll just say one thing. We expect our government to govern. We expect the government to do things that are good for the people and not the alcohol industry. Our interests are mutually exclusive.

The Chair: Thank you very much.

Madam Picard.

[Translation]

Ms Picard: I don't have any questions.

[English]

The Chair: Mr. Szabo.

Mr. Szabo: Thank you, Jane and John. I congratulate you for carrying this torch for at least fifteen years, and probably more.

Certainly some issues are coming into focus. It has to do with effectiveness.

The numbers you mentioned, 19,000 deaths: have you any idea what's happened to the number of deaths in Canada as a result of alcohol abuse? I think the 19,000 figure is for 1994 or 1993. Is there some reference point for which way that's moving?

Mr. Bates: Strangely, as we pointed out, something like 10% of the people in the country have an alcohol problem. That 10% is true in Sweden, where they have very strict laws. It's true everywhere. That 10% seems to hold pretty steady. From the impaired driving point of view, more people say they drive after drinking now, actually, than did fifteen years ago, when we first got started.

Mr. Szabo: You mentioned you've been fighting the industry. You said they're very powerful. I can't say I've ever been up against them on an issue before. Can you elaborate a little about why you feel so strongly about us being aware of this lobby effort and what it can do.

Mr. Bates: The people who are in favour of this bill, as the previous speaker pointed out, have no axe to grind in this thing. I don't get paid one penny for what I've been doing for fifteen years. I've been totally a volunteer. I have nothing in mind except an interest in public health and safety. My dad, Dr. Gordon Bates, was a very well-known doctor. He got the Order of Canada. It all goes back to that. If we're interested in public health and safety, we all have to do something other than just pay our gas bill before we die.

Mr. Szabo: I have one last question. There is another aspect I've come across, and I'd like your opinion on it. The argument would be that Canadians have a right to know about products that can harm their health if misused, and we have that in much labelling. What would be your reaction if it were decided not to proceed with some form of labelling in terms of your right to know or right to let people know and make their own decisions? What would be your reaction?

Mr. Bates: I'd be just as angry as I've been for fifteen years. The power of this lobby we're talking about has been able to keep alcohol as a special-status drug. Most people don't even think of it as a drug, and it is. That's how powerful this lobby is.

I would think this committee would form a subcommittee to find out why alcohol has this special status. It's the only consumable without labels.

If you could read this on a cold pill, for example.... Norman Panzica told me yesterday - and he's one of the best drug men in the country - that one plus one equals four. If you're talking about, say, 10 milligrams of diazepam and a beer, all of a sudden the effect on the brain is like that of four beers. Here we have an impaired driver, and his alcohol content wouldn't even show up in a breathalyser. We don't know how many people have been killed by that.

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Any drug that affects the central nervous system has a synergistic effect with alcohol, including a cold pill. If you read what not to do with this thing, which is to not combine it with alcohol, you wouldn't take it in a million years. Yet there's nothing with alcohol that says one shouldn't take it with this.

Shouldn't people who have a cold be warned not to drink beer if they're taking cold tablets, antihistamines? Does it make any sense not to? That's craziness. We can't understand it. I certainly can't.

The Chair: Thank you. Dr. Hill.

Mr. Hill: Thanks very much. You didn't really answer the question that Paul asked you in terms of the prevalence of problems with alcohol. We've been told quite strongly that the program to reduce drunk driving has had an effect on drunk driving. So is there a change in prevalence over the last ten years?

Mr. Bates: No. I guess you would call it an anomaly. Impaired driving is something that everybody is opposed to doing publicly, but they do it privately. As I said, the studies show that more people actually now drive after drinking than before.

The death rate is going down, but that has nothing to do with a reduction in the impaired driving incidents. It has to do with radial tires, seat belts, air bags, crash parts on cars and better highways.

That's why the injury rate is going up, however. So the number of impaired driving crashes, if you go by the police statistics, is going up.

Mr. Hill: All right. I presume that because you don't focus in on fetal alcohol syndrome here as a significant issue - you're talking more about driving and use of cold tablets and what not - then you would not favour a simple graphic label showing a pregnant woman with an X across it.

Mr. Bates: I'm not saying I wouldn't favour that; I would favour anything at all that removes the special status of alcohol. That would certainly be the camel's head in the tent. Of course I'd certainly be in favour of that.

Mr. Hill: Paul's suggestion here is for a verbal label that addresses the specifics you're concerned with. So what I'm saying is that my idea of the graphic label wouldn't really suit your purposes, I presume.

Mr. Bates: It wouldn't necessarily suit our purposes, except that it would be a beginning. Certainly we would be in favour of anything. It could be just something along the lines of saying that alcohol isn't necessarily good for you all the time.

If these people can put it on here - this is Sweet `N' Low - which says you should not use this except on the advice of your doctor, but everybody is using it, then why can't alcohol put it on?

Mr. Hill: Finally, I must say that your description of these teenagers in the Molson ad sound like my teenagers running down cliffs.

Mr. Bates: That's exactly the problem. This exact same lobby I'm talking about convinced the Ontario government, the Ministry of Consumer and Commercial Relations, to remove dangerous activities from the advertising regulations under the Liquor Licence Act. That's what they did. They're strong enough to do that. So it's okay to show kids who are obviously beer drinkers jumping off thousand-foot cliffs with parachutes. That's just dandy by them. They don't care. They're selling beer. That's their business.

We're trying to save lives. That's our business, yours too, and obviously Mr. Szabo's.

The Chair: Mr. Scott.

Mr. Scott: This is just in reaction to the suggestion about drinking and driving. I don't have any reason to believe this, except I'm assuming this instinctively. Wouldn't it be a fact that the public relations exercise around drinking and driving has made people aware of the fact that they used to define drinking and driving as driving around drunk, and now they define drinking and driving as drinking and driving.

Mr. Bates: I wish they did.

Mr. Scott: So the incidence of people who would answer yes to drinking and driving simply means that people are aware of the fact, more so than they were twenty years ago. They would have thought drinking and driving meant that they couldn't walk, so they would drive their car. Now they realize it's drinking and driving.

Mr. Bates: You're entirely right. It used to be funny. We used to hear things from Dean Martin. For example: ``I was looking for my keys in the parking lot when some fool stepped on my hand.''

You used to hear that; you don't hear those jokes any more. It's not funny, as Jane and thousands and thousands of Janes in this country will tell you. Some 1,500 Janes are created every year.

Mr. Scott: I just didn't want it to be construed as a suggestion that somehow all of this hasn't had an effect. I think it has had a profound effect, such that people are conscious -

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Mr. Bates: That's the problem: everybody knows you shouldn't do it. Probably 100% of people know you shouldn't do it, but they're still doing it. It's those in that 10% who are the bad ones.

The Chair: Thank you, Mr. Scott.

Could I ask a question, too? You talk about the onus of responsibility on the alcohol industry. A few years back, the government put the onus of responsibility on bars, taverns, or whoever is serving alcoholic beverages. If someone leaves that bar and is involved in a serious accident on the way home, the onus of responsibility is on the owner of that bar because he has served that person alcoholic beverages.

How did we put the onus of responsibility on the bar without putting some kind of onus of responsibility onto the beer or alcohol industry? Has anyone ever placed a lawsuit or a class action suit against the industry at all in this case?

Mr. Bates: You've already heard from Dr. Robert Solomon of the University of Western Ontario, who is probably the leading expert in this country on that particular problem.

Sooner or later, I think that's going to happen. I believe the law actually says that it's the last person who serves them. In other words, if a person came into a bar with a BAC of 0.08 and left the bar at 0.165 and killed somebody, then the last person who served their drink, under the server liability, is liable.

Why that hasn't been taken back to the beer.... If I were in a beer company, I'd be worried silly about that, frankly. Someday somebody's going to say that they've been drinking this particular brand.

The Chair: I think we made your lawsuit happen with the silicone breast implants. This is when the women of the States and Canada finally said that they had enough of this. They put together a class action suit. I'm just surprised and amazed that something like this has not happened in this country. You say it's about to happen, is it?

Mr. Bates: I think ultimately it would.

The Chair: Are there any other questions? If not, we'll release the witnesses.

Ms Meldrum: I would like to say that we do seem to be zeroing in on fetal alcohol syndrome as the only warning on the bottle. I don't think this should be the way it should go, because alcohol is involved in every crime. I go to appeal court and I listen to those crimes that have happened. From manslaughter to murder to child abuse to sexual abuse, alcohol was involved. You keep hearing the judges say that alcohol was involved in a case.

So I think it should be an all-covering warning. Alcohol is not treated with the respect it should be. Alcohol is not treated and looked upon as being the dangerous drug that it is. It's such a mind-altering drug, and no one will give it its due. It should be used with great caution.

Mr. Bates: Some 50% of all violent crime is alcohol-related, including sexual assault. You name it. I agree with Jane that you have to start somewhere.

The Chair: Thank you very much for coming in. You're two very important witnesses.

Mr. Bates: Thank you for the opportunity.

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The Chair: Order.

We're delighted to have as our next witnesses, from the Government of the Northwest Territories, Floyd Roland, member of the Legislative Assembly for Inuvik; John Quirke, Deputy Minister, Department of Safety and Public Services; and Alan Downe, Senior Adviser, Special Projects, Department of Safety.

Welcome, gentlemen. You've come a long way, and we're looking forward to your presentation. I'm sure you're going to enlighten all of us as to where we should go.

Mr. Floyd Roland (Member for Inuvik, Legislative Assembly of the Northwest Territories): Thank you, Madam Chair.

My name is Floyd Roland. I'm the member of the Legislative Assembly for the constituency of Inuvik. With me this morning are two officials from the Department of Safety and Public Services in Yellowknife: Mr. John Quirke, who is the department's deputy minister; and Mr. Alan Downe, who works as a senior adviser and has been coordinating a major review of the territorial liquor legislation.

I would like to bring greetings from the Minister of Safety and Public Services, the Hon.Jim Antoine, who has been unable to attend these hearings today because of previously scheduled commitments in his constituency of Nahendeh. I know Mr. Antoine is very interested in the progress of your review of this private member's bill, and I am pleased to be able to represent the Government of the Northwest Territories on his behalf.

Madam Chair, the issues you are considering with regard to Bill C-222 are important ones for the residents and the government of the Northwest Territories. We have been concerned for a long time about the health and social problems associated with excessive or irresponsible use of alcohol. In recent years there has been increasing concern over the incidence of fetal alcohol syndrome and the effects within our population. Death and injury related to impaired driving or occupational accidents are just as devastating to families and communities in our jurisdiction as they are elsewhere in Canada.

.1005

We believe that by increasing public awareness of the risk associated with the excessive or irresponsible consumption of alcohol it is possible to make significant progress in addressing these concerns. We believe consumers who come to liquor stores in the Northwest Territories and all across Canada should be informed that certain risks are associated with the personal decision they have made about whether to drink liquor and about how much to drink. That is the reason why in 1992 the Government of the Northwest Territories approved a policy that resulted in health warning labels being affixed to alcohol beverage containers. We have continued to do that ever since. We are one of only two jurisdictions in Canada to do this. The Yukon is the other.

Our labelling program is a mandated responsibility of the NWT liquor commission and is carried out through arrangements with private owners and operators of our liquor stores. Store personnel stick adhesive labels to bottles of wine and spirits and to the cardboard case, or one on each six-can package of beer, before their placement on the shelf.

Our experience with this program has been positive. We have found this labelling is effective in raising consumer awareness of risks associated with the consumption of liquor. It has been an important, if not essential, component of our health promotion efforts with regard to alcohol.

Because of our experience in this area, we are pleased to see a bill amending Canada's Food and Drugs Act come before the House of Commons, and we are even more pleased to see it resurrected following the original death on the Order Paper. We are grateful for the opportunity to provide you with our comments on the bill and our perspective on some of the evidence that has already come before your subcommittee.

We want to say, first, we strongly support the enactment of Bill C-222. In the Northwest Territories we know putting health warning labels on alcoholic beverage containers is a good thing to do. We know it is effective. If this private member's bill fails to become law, we will continue to provide our labelling program through the NWT Liquor Commission. Either way, the people of the Northwest Territories will see warning labels when they purchase liquor at stores in our jurisdiction. However, we believe general awareness could be strengthened if this message were available to all Canadians.

Further, during public consultations undertaken as part of the territorial liquor law review, many participants questioned why the government and not the industry was bearing the responsibility for funding and delivering the labelling program. The proposed amendments to the Food and Drugs Act would have the effect of ensuring a consistent message is provided to all provinces and territories. That would shift the onus for providing the message to the liquor industry, where many northerners feel it belongs.

We have been very interested in your proceedings to date, and we would like to take a few moments to offer comments on some of the evidence now before your subcommittee. Some previous witnesses have claimed research into health warning labels has proven they are ineffective. We are not convinced this is true. The most that can be said is that the existing body of research is inconclusive. There are problems in drawing generalizations about studies which have examined blended liquor-labelling practices in the United States and applying them to the effectiveness of warning labels in the Northwest Territories or those proposed in Bill C-222. Also, we have noticed many studies have tended to examine the impact of warning labels in isolation rather than to consider them as one component of an overall health promotion strategy.

We have also followed with some interest the presentations received from some witnesses on the impact of labelling costs on breweries, wineries, and distilleries in Canada. Frankly, these arguments have been overstated. There is no denying some additional costs will be associated with implementation of new labelling processes, but we question whether the impact will be as financially damaging as was suggested by some of your witnesses on May 2.

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Indeed, in the Northwest Territories we have just about the most inefficient process anyone could imagine for labelling liquor products and we have virtually no economies of scale, and still the total yearly cost of our labelling program is less than $60,000. We have confidence our Canadian liquor industry possesses the technology and production expertise that will allow it to minimize costs associated with a credible and visible labelling program.

It has also been suggested, however, that if the industry is required to spend money labelling products it will be unable to support current awareness programs and responsible use advertising. Again, we have trouble believing this. We know considerable marketing value is attached to the awareness campaigns it has launched. We know, for instance, that when people see the Brewers Association of Canada poster of Paul Molitor getting into a taxi to get home safely, they are thinking about the message that one should not drink and drive, but they also say to themselves, hey, Paul Molitor drinks beer.

When Canadian distillers promote the idea that a drink is a drink, they are also sending the message that consumers should regard spirits in the same way as they do wine and beer. These indirect messages are a powerful way to focus consumer awareness on liquor even if specific brand names are not mentioned. They also encourage Canadians to think of these companies as responsible and trustworthy. Should we really believe the liquor industry would forgo the opportunity to send out these powerful messages because of the cost of labelling? Probably not.

Finally, we take serious issue with some of the comments opponents to Bill C-222 would offer about the unintended harm of warning labels. We are aware of claims that warning labels cause undue stress for pregnant women, and we know some comments have been made that labels could even lead to an increase in abortions. We have found this argument offensive and speculative.

We use wine labels in the Northwest Territories. They are not causing panic amongst pregnant women. In fact, we find quite the opposite, that they stimulate a thoughtful and rational awareness of the risk of alcohol consumption during pregnancy.

In short, we support the concept of labelling alcohol beverage containers and would encourage the enactment of Bill C-222. Warning labels send a message that industry and governments together recognize that they are selling a unique product and that they are aware some risks are associated with its use. Warning labels set the stage for other awareness programs and health promotion strategies. We would like to see them on alcohol beverage containers in every Canadian province and territory.

At the same time, we would like to offer a number of recommendations on ways in which this bill could be improved. Labels are more effective when they are clearly visible. We would suggest specific minimum standards might be included, perhaps in regulations for the appearance of the label. These could include requirements for a colour that is distinct from that on the manufacturer's brand label, a minimum font size, and a minimum label size.

Labels are more effective when the message is clear. We would suggest the message should bear a heading that indicates it is a warning. We would also encourage the use of plain language. With our NWT labels, we have found it effective to use the word ``you''.

In the Northwest Territories we know impaired driving is not a problem limited to operators of automobiles. In the north, as in other parts of Canada, people are injured or lose their lives when they drink and drive motorcycles, boats, snowmobiles, and all-terrain vehicles. We would encourage changing the message to substitute the words ``motor vehicle'' for ``automobile''.

Introduction of this new legislation should be accompanied by a Health Canada strategy aimed at evaluating its effectiveness over a five-year period.

However, none of these recommendations for improvement should be seen as cause to slow the passage of this bill. We believe the time for action on this matter is now. Minor improvements, if necessary, can be made in concert with or after the initial implementation of labelling practices.

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In closing, Madam Chair, we thank you again for the invitation to appear before your subcommittee and wish you wisdom in your deliberations on this important bill. Also, Madam Chair, I'd like to point out that we have brought a couple of examples of the liquor labelling that we've attached to the bottles. Thank you.

The Chair: Thank you very much, Mr. Roland. It's nice to hear from someone first-hand who has initiated the program. I'm sure there are lots of questions.

Madame Picard.

[Translation]

Ms Picard: Thank you for your presentation. Mr. Roland, I would like to know what motivated these governments to take measures concerning the labelling of bottles.

[English]

Mr. Roland: Madam Chair, we had organizations approach the government with concerns in that area when we were reviewing the Liquor Act. I will point the more technical questions to Mr. Quirke.

Mr. John Quirke (Deputy Minister, Department of Safety and Public Services, Government of the Northwest Territories): Thank you, Madam Chair.

In the Northwest Territories we do have concerns about the effects of alcohol in our remote communities. The people of the Northwest Territories have asked us through various associations, the NWT Status of Women Council and those types of organizations, to please do something to alert the population to the effects of alcohol. In this way the people were listened to by the members of the legislative assembly to the point where in 1992 we put on those labels.

[Translation]

Ms Picard: I would like to know what happens to people who cannot read or who speak another language.

[English]

Mr. Quirke: Madam Chair, it's our feeling that when people are going to purchase liquor or drink, they are of an age to be able to read very clearly. It's only in English. We do know that those who do not understand do in fact ask, and that is what my personal experience from my own perspective has been.

[Translation]

Ms Picard: People who want to buy alcohol will go into any store that sells it and will grab a bottle even if they can't read. If they feel like drinking, they will buy some wine.

I would also like to know whether you intend to implement any measures other than labelling, such as a public awareness campaign.

[English]

Mr. Roland: We do have a health promotion strategy of a sort in the NWT. Being on the standing committee of a social envelope that deals with health, education, justice and housing, I know we are working together with these departments in promoting a message out there on the use of alcohol. Also, there are other groups that have become more aware, especially since FAS and FAE have come about more. They are realizing that a large number of our population is affected by such things.

For more information, I'll pass to Mr. Quirke.

Mr. Quirke: In response specifically to what our programs do, yes, we do have other programs in the Department of Safety and Public Services that are responsible for the liquor commission.

For example, if you go into one of our liquor stores in the Territories and you buy a bottle of wine, it's put into a bag. There are two messages on the bag. One says ``If you drink, don't drive''. The other says ``For the baby's sake, don't drink''. We have also published books about health and alcohol and all about alcohol, both in English and in Inuktitut, to reach our consumers in the eastern Arctic. We do use materials from other sources as part of our ongoing program of public awareness.

Mr. Alan Downe (Senior Adviser, Special Projects, Department of Safety and Public Services, Government of the Northwest Territories): In addition to what is happening with the Department of Safety and Public Services, other departments are very much involved in a multifaceted health promotion strategy, of which we consider health warning labels to be an important component.

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Over the last few years we have succeeded in developing 43 community-based alcohol and drug agencies, in many cases in small communities. These focus specifically on community education, awareness about alcohol and drug use, and putting on prevention programs in schools and in the communities.

In schools, our school health curriculum also includes drug and alcohol education modules. These programs include information on addictions and making responsible choices. Many teachers we know tie in the information that's on the health warning label as part of those classroom presentations.

We participate actively, as do all jurisdictions of Canada, in the annual addictions awareness week activities, again focusing on issues related to individual choice: making yourself informed - as consumers you have the right to be informed - about the health effects of alcohol.

Overall, recently as well our government has placed a high priority on community wellness. This is a new approach that we've embraced, one that emphasizes the importance of letting northerners know where health risks are and where the help is for dealing with those heath risks and helping them make informed choices about healthy lifestyles. Again, that's the kind of message that we find health warning labels tie into very appropriately.

Thank you, Madam Chair.

The Chair: Thank you.

Dr. Hill.

Mr. Hill: You are the gentlemen who I had hoped would come here and say to us, ``We have four years of experience and these are the things we can show''. In having you come here, our keen desire was to be able to do that. Obviously, if you've done a bunch of things you can't pinpoint these, but can you show something data-wise - FAS reduced, accidents on snowmobiles reduced, something that would say that this has been effective?

Mr. Roland: We have some results from the liquor commission review that's been happening. I think that generally as a population we've seen the effects already, but for the more concrete things we do have some information, which Mr. Downe will show you.

Mr. Downe: That is a very difficult question to answer, as you know, sir. It's a very difficult type of research to do. Many of the studies that have gone before have results that are very difficult to generalize in many ways, because the research that's been carried out has dealt with the American labelling program. If you will compare the size and visibility and apparent effectiveness of the American labels and the NWT labels that we have just underneath on liquor products from the U.S. that are sold in our stores, you'll see that there's a big difference. Whether you can generalize results of studies done on the American labelling program to our effectiveness is something we have real concerns about.

Having said that, I would also like to mention that one can get carried away with studies. I think in the north we have learned a lesson over the years: that spending thousands or hundreds of thousands of dollars on southern sociologists to carry out studies that have a rather limited generalizability and rather limited validity may be not as valuable a use of our resources as dealing with people in a more traditional fashion, going out into communities and listening to what they have to say.

This is what we've been doing over the last couple of years with the liquor law review. Certainly the feedback that we've got through public consultation, through public meetings, has told us that people in communities believe that health warning labels make a difference. They have a lot of stories that we could share with you if we had more time - little anecdotes about how they know that's made a difference.

Setting that aside, we also know that in every year since we introduced the health warning labels program there has been a modest decrease in alcohol consumption in the Northwest Territories. We're no longer the highest consumers of alcohol in Canada.

We know there's been a reduction in property damage and deaths due to collisions in motor vehicle accidents.

We know there has been an increased number of referrals for addictions treatment and that there has been increased prenatal care.

We know there is a much greater awareness, that's there's much more discussion at the community level - believe me, I heard a lot of it when we were doing these public meetings on how we should change our liquor laws - a much greater awareness of the health effects and health impact that alcohol can have.

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Madam Chair, I would be misleading you if I attributed all of these changes to health warning labels. Certainly our reduction in property damage due to motor vehicle accidents probably has a lot to do with the fact that we have better roads. The other awareness strategies that we just mentioned a moment ago certainly have an affect on health awareness. But we believe health warning labels are an important component of what we've been doing in this area.

Mr. Hill: The labels, you've said, cost $60,000. We were given figures like 7¢ per bottle for labelling, and obviously this is not a 7¢-per-bottle label. How much is it per label on the bottle?

Mr. Quirke: A roll of 500 labels costs us $1.50. The total cost of applying the labels to approximately 1.9 million containers was $57,000.

Mr. Hill: Could that manual application of labels be done in a much larger market, Canada-wide?

Mr. Quirke: As Mr. Roland mentioned in his presentation, how we do it is probably not the most effective, efficient way of using labour to affix labels to bottles. There's no doubt about that. In terms of doing it across the whole country manually, no, I don't think it would be very effective when you're dealing with 15 million people...the province of Quebec. There are about 65,000 people in the Territories, with sales of about $20 million. As I say, it's not a very efficient way of doing it, but we do it anyway. It doesn't cost us very much - maybe 0.002¢ a bottle. I wish we could do it much better in terms of putting it on through a mechanical means, etc., but it is definitely worth the effort.

The Chair: Thank you very much, Dr. Hill.

Mr. Scott.

Mr. Scott: Thank you very much, Madam Chair.

I can't resist the opportunity to observe that while all the rest of us have green labels, Dr. Hill has abandoned his green label for a blue label. I'm not sure what that means.

Some hon. members: Oh, oh!

Mr. Scott: I wasn't going to ask a question, but I'm compelled to as a southern sociologist - I'm kidding.

I'd like to redefine the question of effectiveness, because to some extent we're having a discussion around the effectiveness of labelling, which is really not where I'd like to have it. I would like to have the discussion around the effectiveness of labelling as per the very specific group - if there is a specific group of people we're trying to get to.

I will be asking the department if they have any research - and if you have research, that would be great too - that would identify whether or not there are any socio-economic indicators that essentially point out who is particularly more likely to be affected, particularly among women who may be pregnant. I don't mean affected by alcohol; what I mean is whether or not there is a targeted group of people who don't know. If the issue is awareness, is there a particular group that is less likely to be aware already? If there in fact is, is this the best way to get that information to them? Having set it up that way, could you respond?

I also really believe the question of literacy is a bigger issue. Pauline mentioned people being able to read the labels. About 25% of the adult population can't read at a grade 9 level in this country. I think it's very important to recognize that this is a bona fide problem.

Mr. Roland: Thank you, Madam Chair.

In regard to the effectiveness of labels and the onus being on government to prove they work, and then in regard to whether or not there's a targeted area that we can look at, coming from a northern community of 3,500 people, I guess my response would be that there isn't only one type of person who goes to the liquor store.

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Mr. Scott: I have to bring clarity to this. What I'm asking is whether there is one group of people who don't know alcohol could have this effect. I'm not talking about who drinks. I'm talking about who is making the decision to drink in an informed way and in an uninformed way, and whether this is the best way to get to the people who are making the decision in a less informed way. That's my point.

Mr. Roland: I believe what we're trying to do is to get to the younger population. With age, with all of us, wisdom comes. We're seeing the effects and going back to that, realizing some of the things done in the past we should be addressing now. We should be giving the younger population coming up into this situation warnings that others have, because we've heard before all about FAS and FAE, but nothing was associated with that before. People looked at groups of individuals and said, well, there's just something wrong with that person. It was never attributed to anything before. But now we have proof it is.

Mr. Downe: I want to follow up on Mr. Roland's comments, very briefly.

We have an extremely young population in the Northwest Territories. To go back to one of Ms Picard's earlier questions, that was one of the motivating factors, that 50% of our population is under 25. That gives us a very large target group in trying to develop that kind of personal awareness that Mr. Roland was just mentioning, the awareness that, yes, alcohol can cause birth defects, alcohol does cause birth defects.

Incidentally, to come back to the literacy question, that target group does read English pretty well. We have an education system in the Northwest Territories that has made leaps and bounds over the years. That target group does read English and they are reading our labels. In fact, just before we came, the Students Against Drunk Drivers organization at one of the Yellowknife high schools heard we were coming and made sure they presented a series of points they wanted us to make about health warning labels, because that's something they believe in. We'll provide that to the clerk.

To come back to your first statement, sir, there are two kinds of awareness. There's personal awareness, where you take the educational value of the label and realize, gee, I'd better find out more information about this. But there's also a general, more public sort of awareness, and we've seen changes in that in the territories too: awareness of gatekeepers, awareness of people who work in bars, awareness of families reflected in family discussions, in public discussions. We see that increasing. I think the value of that is immeasurable.

When I attended Acadia University, where you were on faculty, I learned about the importance of being careful with that kind of research, yet I learned about the power there is in widespread general awareness.

Mr. Scott: I'm not sure who was on the faculty at Acadia. Under the circumstances, given the credentials questions people have been asked, I'd better set the record straight: I'm not the one.

Mr. Murphy: I'll take the blame. I taught in the sociology department at Acadia part-time for 25 years.

I compliment you for your presentation. It was really well done. I also compliment you for your trail-blazing efforts. You've introduced a number of interventions to get at a problem you obviously have recognized, as a people of the north.

Many of the questions I was going to ask have already been asked.

When you were doing this, what was the response of the industry to your putting the labelling on, and was there any discussion with the industry about a cost-shared partnership in doing this project?

Mr. Quirke: This was an initiative done entirely by the Government of the Northwest Territories in response to the concerns raised by its residents. There was no communication whatsoever with the industry.

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You used the word ``partnership''. Although in many ways I believe there is always room for partnerships in many endeavours that we undertake, as a general statement I would be very concerned about any type of partnership with the liquor industry. We are concerned about the health of the residents of the Territories. The industry is concerned about the health of its own business. With these two different philosophies, different motives, different perspectives, it would be very difficult or there would be limitations to forming any type of partnership with the industry.

Mr. Murphy: Did you have any response from the industry as a result of putting the warning labels on?

Mr. Quirke: The industry has never made any formal presentation whatsoever to the department or to the government about our health warning labels.

Mr. Szabo: A lot has been talked about in terms of effectiveness. One of the things that concerns me is that the data coming out and all the research studies I've been able to get from the Library of Parliament and the Addiction Research Foundation library seem to be 1992 or 1993 stuff. The data is not very current.

I'd like to put this on the record from the Alcohol Research Group at the Medical Research Institute of San Francisco in Berkeley, California, dated February 17, 1992. They're talking about what happened after the first few months of implementation. In the abstract, which is a summary of the article, it says:

After controlling for demographics and alcohol consumption, respondents who probably saw the warning labels were significantly more likely to report several behaviors indicative of heightened awareness of, and caution regarding, the hazard of drinking and driving and of drinking during pregnancy, hazards that are both included on the warning labels.

This is with regard to the first six months of implementation.

I have another study here from the same organization, and it says that during the first six months of the implementation, two-thirds of the bottles did not have the labels on yet, because of the lag of inventory. So there wasn't even a reasonable chance during the first six months, but they still had significantly increased awareness.

Because the Minister of Health has raised the issue of effectiveness, my question has to do with awareness.

The head of the Brewers Association of Canada appeared before us on May 2 and presented testimony that it was found that virtually the entire population, 95% and more, were aware that alcohol could cause health problems, especially during pregnancy, and that excessive drinking impaired one's ability to drive or operate heavy equipment. The industry has said that 95% of Canadians are aware of these things already. I think, subject to check, that later in their testimony they said that they're still going after the other 5%.

Could you comment on the industry's assertions regarding awareness?

Mr. Roland: We in the Northwest Territories don't believe in those numbers. As we've been finding out, if you've got the power and the dollars to put into a place, you can make the numbers say what you want them to say. This is not to say that I'm making any allegations.

We know from the population in the Territories that there is a large population base that is not illiterate. They can read and they understand and they watch programs. But if you went on the street and talked to them and asked, as you heard earlier this morning from your first presenter, on the issues - ``Do you know exactly what this causes?'' - you wouldn't get that 95% response.

Mr. Szabo: You made a decision on your own because you're into public health. I'm interested also in the whole idea of the government's responsibility to inform and the right of your citizens to be advised or cautioned when they're dealing with a substance that could harm them. I'm not sure if your government has a position on this.

What would be your response to the statement that governments should not pick and choose what products they will warn are hazardous, but they should give the public all the warnings based on definable criteria and allow them to determine which ones they're going to believe or follow?

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Mr. Roland: When it comes to the health issues, we've taken this on our own because of the major fact that we see its effects are ongoing, not only on children but on families and on the cost of the education system, special needs and so on.

We look at it as a government. It's our responsibility to protect all the people, not just a limited few. And at what cost? We're already paying a phenomenal amount of money to deal with the after-effects of alcohol: long-term disabilities and so on.

So we've taken the stand that we have to do something about it, and we're becoming proactive. For years and years the governments have been reactive - doing something after the fact, trying to make things right by putting a band-aid on them - but now we're getting proactive. It's time to do something about it. That's what we've started.

Mr. Szabo: Madam Chair, I would like to formally congratulate the Government of the Northwest Territories for showing leadership on this very grave health issue. Thank you.

The Chair: Madam Picard.

[Translation]

Ms Picard: You are undoubtedly aware that in the past few years, in Quebec, following drink/don't drive awareness campaigns, we've observed a decrease in the number of young people who drive drunk. These awareness campaigns, which were conducted through television and advertising, have been established and funded by the Quebec government in partnership with various alcoholic beverage producers.

Young people took charge of themselves and were made very aware of the fact that one must not drive drunk. When they go out at night, they designate a driver and that person will not consume any alcohol at all. They arrange things amongst themselves and everybody takes their turn.

Do you really believe that labelling alone is a significant enough measure to raise public awareness of foetal alcohol syndrome and the dangers of drinking and driving?

[English]

Mr. Downe: Definitely not. If we have conveyed the impression that we're saying labelling alone, all by itself, will achieve those, then we've erred today.

However, we believe and we know from experience that putting warnings on the product itself is an important component of the kind of health promotion campaign that would lead to the sorts of outcomes you mentioned. We believe the cornerstone, in some ways, is product labelling.

And even if it isn't - even if the efficacy of it is perhaps in question or if the research is inconclusive - I believe the direction we've received from our government is if an error is going to be made, err in the public interest. Make sure we are doing everything possible, that we're using every one of the tools in our toolbox to make sure our health promotion campaign is effective.

Thank you, Madam Chair.

The Chair: Thank you very much. I think our time has run out.

One of the messages I'm hearing from you is that we as a country and as Health Canada have a responsibility to our citizens to notify them of all dangers, whether it's drinking or whatever. This is one area, I suppose, where we have been a little bit negligent. I don't know how we're going to go around and slap all those labels on bottles, but we'll have to figure that one out.

Thank you very much for coming. You've come a long way and your presentation has really given us food for thought. Thanks so much.

Mr. Quirke: Thank you.

The Chair: The next presenter will be Dr. Guilfoyle. Dr. Guilfoyle is from the Council of Chief Medical Officers of Health. His submission has only arrived in English, so we will have to send it to the translator before we can circulate it.

Is that correct, Dr. Guilfoyle? Thank you.

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The Chair: Welcome, Dr. Guilfoyle, and thank you for coming. We've had some very interesting presentations over the past couple of weeks. This is the last week, and you're one of the last presenters. We look forward to hearing what you have to say. Please go ahead.

Dr. John Guilfoyle (Chair, Council of Chief Medical Officers of Health for Canada): Thank you very much indeed.

[Translation]

I'm pleased to be making this presentation this morning.

[English]

I won't continue in French, but I just wanted to acknowledge the importance of that particular dimension.

I have some overheads, which unfortunately some of you can't see unless you look around.

As the chair of the Council of Chief Medical Officers of Health for Canada, I want to tell you a little bit about what the council is. It's a collective or group of the most senior public health officials from across Canada. Most of us in our jurisdictions are responsible for upholding and administering the public health legislation in our provinces and territories. We feel that as a group of public health officials we have some responsibility to recommend measures that seek to promote and improve the health of Canadians.

On the next overhead you'll see the cast of criminals, the chief medical officers of health of the various provinces and territories.

We see and support a vision, and the vision is of healthy people in healthy communities. We are consequently committed to promote, improve and protect the health of Canadians, which is a vision that is not unique to chief medical officers of health, but we feel is shared by many of the other organs of our society, not just restricted to the health care sector.

Why are we here? It isn't just about alcohol labelling. We're going through the throes of a real change in how we're approaching health. We're beginning to see - and it's not new, but our realization may be - that the impact on our health of everything we do is something we need to be concerned about as we realize that the over-emphasis on illness care and the large expenditures that we have throw into relief that we may be underspending as a society on those determinants of health that keep us healthy. What are the factors that are good for our health, that keep us happy? They're jobs, good family relations, the kind of environment that we live in, and the behaviours that we choose.

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We're being challenged as a society to look at strategies that keep the population healthy. What do we base those strategies on? We base them on evidence, and we base them on principle and on values. From my perspective as a public health practitioner, hopefully we also base those on what is good public health practice.

So, really, that's the context of being here - to discuss alcohol, to discuss this society's relationship with alcohol. It sometimes escapes our attention that it's a powerful chemical substance that is addictive, mind-altering and pretty well toxic to everybody's system that you care to mention. In the burden of disease in our society, it does almost as much physical harm as tobacco. We can think of cancer of the mouth and throat, liver disease and neurological damage, nutritional deficiencies - a number of things. It is the most common drug of dependency used in Canada.

Contrary to what has been focused on, moderate drinkers, those in the middle, have most of the problems. We have a small subset who have a huge amount of problems, and they're over-represented in our prisons, over-represented in fetal alcohol syndrome, and some of the things you've been hearing about. But if you take the massive problems related to alcohol, most of them affect the health of what would be the moderate drinker, because there are a lot of moderate drinkers.

The other thing about alcohol is that the more we drink, the bigger the problem. It's been suggested as a public health strategy by a number of bodies - the Royal College of Physicians and Surgeons of Canada; Canadian Medical Association - that we should reduce the per capita consumption of alcohol from where it is at about eight litres per capita per year to six litres as a public health strategy.

So how do we get there? Does alcohol labelling have a role? If we're interested in a healthy public policy, which I believe is the over-arching goal of every organ of governance, we need to promote, protect and preserve the health of population. So what strategies are useful?

The broad strategy is one of awareness. That's where we start first. If we're not aware of the problem, we're not going to do anything about it. Awareness leads to concern, and concern leads to action. That's the continuum of all societal change. That's what happened with tobacco. That's what happened when we gave women votes. That's what happened in a whole host of things that we thought could never happen. Thirty years ago, the concept of a physician standing and talking about smoking as a societal problem would have been laughed out the door because this profession - my profession - was over-represented in those who smoked at that particular point in time.

So what about this legislation? The proposed legislation is useful. It's a symbol to Canadians of a change that we're seeing: there is an injurious influence to the common good and to health and we want to inform, educate and make everybody aware. The industry, the consumers, everybody in our society, need to realize that the wraps are off. Alcohol is the source of huge amount of suffering and morbidity - you've heard it all in detail - and we need to know about it. It's an educational tool. It's maybe not the best, there may be others better that could be used, but it's a useful one and a good one.

It's a barometer of our concern. If we label everything from footwear to Hoovers to baked beans, we might as well label alcohol. It's an expression of our shared value that we're concerned that others we may know.... I know the impact of alcohol, but I'm not sure every kid starting to drink does, or that every mother or everybody else does. So it's a barometer of our shared value that we're interested in the health of others.

And it's a commitment to the health of all, now that we have more science and more knowledge, that we're not going to stand by and let a substance that has injured generations and generations of health, a substance that has created carnage over the centuries, to continue to do so. We are at a different point in time. The data is in. Alcohol as a drug of recreation creates harm, so there is a public health and population health strategy that we need to get into to address that.

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Some of that already has happened, and it's consistent with healthy public policy. If we're going to put the goal of public policy as being to improve, promote, and protect the health of all, it's consistent.

I've a couple of suggestions that might improve this legislation. I think we should broaden the health warnings. I don't think we should target just women. I don't think we should target those who drink and drive. I feel if the average red-blooded Canadian male knew alcohol makes your testes smaller, there might be a bit of crossing of legs in the various bars and a bit less enthusiasm for getting to the tenth beer.

Alcohol has other effects people could and should know about. It affects infertility. It affects immunity. It has a wide range of both subtle and profound health effects. I think we should focus-test any messages for clarity, for comprehensiveness. We should consider other languages. We should consider symbols, because the idea of literacy is an important issue.

I heard the statistics there earlier. In the health promotion field you must remember 40% to 60% of your population read at a grade 6 level or below. So you need to make your messages simple. You need to think of symbols.

The other problem, and I guess the biggest stumbling block in all of this, is the industry. As a population health policy, and as a healthy public policy, I think the information is clear we need to reduce the amount of alcohol we use as a society. Now, there is a challenge that maybe a small amount is good. We haven't defined that yet, and we should put it on the labels if we do find there is evidence to support that. But in the meantime, the strategy that makes sense from a public health point of view has to be to reduce the amount of alcohol we consume in Canada and in the world. That is consistent with the World Health Organization, consistent with many public health authorities. That means the industry is going to sell less beer, less liquor, less spirits. That's the message.

So, guys, let's get with the program and work out how we can work with you; work with the farmers who are going to be planting less malting barley; work with the whole hospitality sector on how we can provide the same kind of entertainment value-added without the destruction-added we have from alcohol; how we can move to having fun together without getting boozed. The human mind has shown itself to be immensely creative about how we can entertain ourselves. We've shown over the centuries that chemicals that interfere with our minds in general create more problems than they solve. Maybe we're into a new dawn when we can be as healthy as we can and have as much fun as can without substances we run the risk of harm from.

In conclusion, this alcohol labelling is a small step, a small piece, but it is a signal piece. It is a watershed in societal concern about this product. I wouldn't want the committee to underestimate the importance of what you are about in terms of healthy public policy.

The Chair: Thank you very much. That's great.

Madame Picard.

[Translation]

Ms Picard: Thank you for your words in French; they were appreciated.

When people buy a bottle of beer or wine, they are often influenced by advertising of alcoholic products. You go to a Société des alcools store in Quebec, and you buy alcoholic beverages. How many people really take the trouble to read the label indicating where the wine is coming from, and how many will take the trouble to read these little labels on the back? That's the problem. The first time you see such a label, it's quite striking, but in the long run, you get used to it. It's like the warnings on cigarette packages. Initially, people were very struck when they read: ``Tobacco can kill''; ``Tobacco can cause cancer'', etc. But today, when I go to the convenience store, I notice that people don't look at these warnings anymore.

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How can we make people aware in the long term of the importance of recognizing that if one is pregnant, alcohol can cause problems for the foetus?

Dr. Guilfoyle: We need a strategy that uses a variety of methods. The labelling of alcoholic beverages is only one small part of a broader strategy to reduce the consumption of alcohol in society. Should we change signs, emphasize another element after a certain time? If we recognize the problem, our goal must be to warn the public of the dangers of alcohol, but the strategies used to achieve that goal can change over time. Announcements and signs can be tiresome after a certain time.

Ms Picard: Thank you very much.

[English]

Mr. Hill: You're one of the first health professionals to say that it would be as reasonable to announce the beneficial effects of alcohol as it would be to announce concern about the negative effects, and yet you want to reduce overall consumption. Those almost sound like antitheses.

Dr. Guilfoyle: Antitheses.... Well, I think we have to make our decisions based on evidence. Data unites; theories divide. If we have evidence that shows that alcohol, on its own, has a useful health effect, I think we should market it. I think we should prescribe it like we do many of the other things that we are giving to the population, if we have that evidence.

Then, I think, we must incorporate that evidence into any health promotion strategy if it makes sense. If it doesn't make sense.... And at the moment, given the preponderance of evidence we have that as a society reducing the burden of alcohol is associated with reducing per capita consumption, it still seems to be a very useful overall health goal to suggest for society.

Mr. Hill: You also said this approach would be a signal, a watershed, but I did hear you say this might not be the best approach. Could you clarify that for me?

Dr. Guilfoyle: Okay. I think the points being made.... For example, there are individuals who go to bars who never see the bottle. They are given drinks from a dispenser. Not everybody is going to be aware of and exposed to this educational component.

There may be other strategies that would complement this, if our role is awareness. This is only one component of an awareness strategy. So when I say if all we do is just do this.... I think we could do better.

Mr. Hill: Finally, you said we could improve it with a symbol. Do you have a favourite symbol?

Dr. Guilfoyle: I really don't. In fact, I have one problem with symbols in health promotion. This is just my own personal bias. Most of our symbols suggest you shouldn't do something.

I'd much prefer some symbols that promote being as healthy as we can be. In other words, it would be some symbol that symbolizes automatically that I'm drug-free, that I'm able to navigate life on my own recognizance, and that I'm not associated with or influenced by drugs.

I think one of the things in a drug awareness strategy is the promotion of the idea that human beings are fairly capable on their own, that they're producing enough endorphins in their chemicals to do themselves quite nicely. Some symbol to promote that would be interesting to me.

In terms of this particular issue, in regard to alcohol labelling, you could have symbols of pregnant women, of driving, and of other drugs like prescription drugs, with a slash through the symbol...you could have a number of things.

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One of the interesting questions is this one: should one parent while drinking? That's an interesting concept, isn't it? How many drinks are there before the advice you're giving your 4-year-old is impaired?

There used to be an old crime called ``overlaying''. And some of our sudden, unexplained deaths in infants are still due to mothers and fathers overlaying their children. ``Don't sleep with your child if you've had a few drinks'' might be another message that has some utility, because in every province there are some deaths every year that are due to somebody who's had a few drinks bringing the baby into the bed with them... they wake up and the baby is dead. They've overlaid their baby. It used to be a serious crime in Victorian London in the 18th century, but it still exists and is related to alcohol consumption.

The Chair: Thank you.

Mr. Szabo.

Mr. Szabo: Doctor, your presentation has improved my education, at least, on some things. One of the things you said, though, that I think brings more focus onto the controversy or the opposition between the health community and the alcohol industry is that as a public health standard you say that the consumption per capita should be reduced from eight litres to six. That's a25% reduction in alcohol consumption.

That must translate into an awful lot of lost revenue and profit for the industry. It's also quite a lot of lost revenue for the Government of Canada. Have you weighed the economic implications of setting those targets? Can you give us an idea of what the net result would be if we achieved that?

Dr. Guilfoyle: As best I know, and I think if we're going to get into the concept of health goals, it's a very complicated process that we really have only begun to think about in this country.... There are many provinces that have started on that road. As best I know, and certainly I'm only a very minor and junior economist, I understand that the impact of alcohol, the downside, the destructive impact, is about $12 billion a year. I'm not sure that if you reduce your alcohol sales by 25% you will have that same impact in terms of revenues. And that's just the fiscal argument.

If one thinks that some of the morbidity might be reduced by 25% - or by some percentage - as well, that's value added. You probably have the fiscal equation right, but I would argue that the societal benefit is much greater than that.

Mr. Szabo: Doctor, are you familiar with the existing labelling in the U.S.?

Dr. Guilfoyle: Yes.

Mr. Szabo: Do you have a comment on the quality of the labelling and on the likelihood of it being effective?

Dr. Guilfoyle: I think the labelling is a little innocuous in the States. It's not that visually attractive. It's difficult to see. The messages are limited to a couple. First, I would argue that it should be visually attractive. Everybody can see the names here. You may not see anything else, but we have the names. One of our challenges in health promotion is that we've had neither the resources or the creativity to make our health warnings as attractive as industries can make their products attractive.

Mr. Szabo: Doctor, as for the question of the public's right to know when there is a dangerous product, I think you may have heard me earlier state that we have labelling in other areas and there are certain criteria that require it. I think even under the WHIMS system in the breweries and the distilleries they already have warning labels inside the factory, because the components of the raw materials are dangerous to workers' health, but when you put them together we don't have warning labels for other people.

Would it be fair to say there's a principle that has to be upheld here about the public's right to know, and there is a possibility that if we fail to act on the alcohol beverages this time, we will lose credibility with the public, in terms like this: ``I won't know what is dangerous for me because they're not being consistent, they're picking and choosing what they warn us about''.

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Dr. Guilfoyle: I couldn't agree with you more.

One of the important things I think we know about in parenting, as it were, is consistency. You have to keep doing what you say you are doing. You have to walk the walk and talk the talk. I think exactly the same applies. I don't want to suggest that government in some way is our parent, not in that sense, but there is a responsibility, a duty of care that I believe government owes to the population in developing healthy public policy and population health strategies, and one should look at least for consistency between the various areas of concern. If we do regulate industry to warn them about the dangers of alcohol, the least we could do is warn the average consumer, who may not be in a position to know even as much as, maybe, a member of a workplace as to the dangers of a substance.

Mr. Szabo: Finally, Doctor, do you have any information for the committee... if you allow for increases in population and normalize the consumption per person? Can you give us any idea about the trend line with regard to impacts of alcohol abuse? Are they flat over the recent years, or are they going up or down?

Dr. Guilfoyle: From my understanding, alcohol consumption has been increasing until recent years. Recently it has plateaued off and may be dropping in certain areas.

I think there's no doubt there has been a reduction in the amount of motor vehicle accidents related to alcohol. I think that's reflected. That's my knowledge. So I think there has been some reduction in that arena.

I think fetal alcohol syndrome is a great area of concern because our awareness of it, and even our ability to diagnose it and track it, is only in its infancy, to be quite honest. It's something we really are only at the start of in cataloguing its impact on society, so I don't know. Fetal alcohol syndrome wasn't something we taught about ten years ago, really. It wasn't something that was on the books. So we can't look back ten years and say things are getting worse or improving. I think we're just at the start of cataloguing the problem.

Obviously we want to catalogue it and see it go right down from here, but again, I think it's too early to tell whether our current campaigns that are ongoing in the various jurisdictions across the country are effective. I have some sense that they are.

Anecdotally, we have fairly high-risk populations in Manitoba. I have heard that there is awareness now among women about the connection between alcohol and pregnancy. But one of the problems, of course, is that if the per capita consumption - the general amount we consume - is the same, the pre-conceptual risk hasn't changed that much. I mean if you're pregnant and you have a baby there and you know about it, well, then you don't drink. But in the first weeks of pregnancy, the first two months, often you don't know, and that's still a problem. No matter what labelling you do, if the overall consumption stays at current levels, we may still not solve the problem we have with fetal alcohol syndrome as effectively as we might if the overall consumption went down.

The Chair: Thank you very much.

Mr. Scott, did you have any questions?

Mr. Scott: No.

The Chair: We really appreciate your coming and making the presentation to us. You have added another dimension. We're trying to fit all of the pieces of the puzzle together, and you've certainly helped. Thanks so very much.

Dr. Guilfoyle: I'd like to thank the committee very deeply. This is the first time that the Council of Chief Medical Officers of Health has presented to a piece of proposed federal legislation that has such important implications for the health of Canadians. So it's a great honour, and on behalf of the council I would really like to thank you for having had us here. We wish you well in your deliberations.

The Chair: As a former chair of the Regional Municipality of Ottawa-Carleton's Board of Health, I recognize the importance of public health in preventive medicine, and I think you're making a major contribution to Canadian health. Thanks very much.

Dr. Guilfoyle: Thank you.

The Chair: We're a little bit behind in time, but I think we can finish here by noon.

We have three representatives from Health Canada: Dr. George Paterson, Byron Rogers, and Ron Burke. We have two other names: D. Jacovella, and D. Cook. Welcome to you all.

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Thank you very much for coming. You've been here for a while, so you've heard some of the presentations. We've had a pretty broad overview from every angle of how we're trying to fit this puzzle together. I hope Health Canada has all the answers now.

Who's to go first? Dr. Paterson.

Dr. George Paterson (Director, Foods Directorate, Department of Health): Thank you, Madam Chairperson. I appreciate the opportunity to address the committee on Bill C-222 and on the important issues of alcohol warning statements.

As you've mentioned, I've brought several officials from the department who will be able to expand on the details I will cover, should there be any questions.

Specifically, I have: Doris Cook, from our health policy and information directorate, who will talk to the policy aspects of alcohol warning messages; Ron Burke, from the foods directorate of the health protection branch, who can discuss the regulatory issues if there is a need for that;Ann Sunahara, from Justice Canada, who is our legal adviser and can discuss some of the legal implications; and Diane Jacovella from the office of alcohol, drugs and dependency issues, who can provide more details in terms of specific prevention initiatives and projects.

I'll try to keep my opening remarks brief so that there is time for the committee to pose questions to us.

At the outset, however, I'd like to reiterate that Health Canada's objective is to maintain and improve the health of Canadians. As such, the department supports the principle of Bill C-222 - that is, of increasing awareness of the dangers associated with the abuse of alcohol.

Despite encouraging declines over the past decade, impaired driving remains a substantial public health and road safety problem in Canada. In 1992, it is estimated that more than1,600 persons lost their lives in alcohol-related motor vehicle accidents in Canada.

As we've heard, fetal alcohol syndrome and fetal alcohol effects are disabling conditions that involve life-long disabilities and have significant adverse impacts on families and communities as well as on our health and community services systems.

Since the report of the Standing Committee on Health on this issue in 1992, Health Canada has developed strategic programming incorporating a variety of activities to address aspects of fetal alcohol syndrome, aimed at curbing alcohol and drug abuse and fostering healthy pregnancies. These initiatives include the distribution of the well-received brochure Alcohol and Pregnancy, a national symposium in Vancouver in 1992, and numerous conferences, workshops and regional needs assessments across the country, as well as numerous child health/substance abuse projects. Should you wish, I'll be able to provide more details on these.

Since 1989, as you are aware, the United States has required a warning label displaying a similar message as being proposed by Mr. Szabo. This message reads:

Government Warning: (1) According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects. (2) Consumption of alcoholic beverages impairs your ability to drive a car or operate machinery and may cause health problems.

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Information that we have received on the U.S. experience indicates ambiguous evidence on the effectiveness of warning labels. They may serve to increase the general level of consumer awareness, but they cannot be linked to behavioural changes with respect to drinking. The department therefore believes that approaches other than labelling may be more effective in meeting the objectives of Bill C-222.

In Canada, I am able to report that since 1989 the number of people drinking alcohol has declined by 5.4%, without warning labels being required on alcoholic beverage containers.

The department has been involved with a number of initiatives that serve a very important role in informing the public on the dangers of abusing alcohol.

In this regard I'd like to provide several examples of programs that Health Canada feels could accomplish the objectives of Bill C-222. These include continuation of the fetal alcohol syndrome and fetal alcohol effects information service, an awareness program re youth and underage drinking, training programs for health professionals on alcohol and other drug issues, and awareness programs on impaired driving.

Health Canada has already used and continues to use a variety of approaches, such as brochures and videos, to reach the public on issues relating to alcohol abuse. Similarly, the provinces and territories have produced brochures, printed messages on bags, television messages, and posters as means of reminding the drinking public of the risks of abuse.

Health Canada would like to continue to work with industry and other governmental authorities on such ventures to ensure that an effective message will reach the public.

Other options the department is interested in exploring include standard drink labelling, as is done in Australia, or warning messages being incorporated into advertising material.

I'd also like to refer to the recent Supreme Court of Canada decision - namely, Hollis v. Dow Corning - rendered on December 21, 1995. This may serve as an incentive for the alcohol industry to provide warning messages by some appropriate means to the Canadian public on the issue of abuse of alcohol.

This decision indicates that manufacturers have a duty of care to warn consumers about the potential risks associated with the ordinary use of their products. That's to say that consumers must be informed of any dangers inherent in the use of the product, particularly where the product is ingested or implanted in the body.

Manufacturers can discharge this duty by providing a clear and forthright warning of these dangers to the consumer.

One way in which manufacturers of alcoholic beverages can discharge their duty to warn may well be to incorporate messages into advertising material. Health Canada would like to explore this possibility further.

Madam Chairperson, I'd like to thank you for the opportunity to address the subcommittee on Bill C-222. I invite any questions the members would have of me or the other representatives of the department.

The Chair: Thank you very much.

[Translation]

Ms Picard.

Ms Picard: Welcome to the subcommittee. The Minister stated recently that he wasn't very enthusiastic about labelling alcoholic beverage containers. He said that this initiative could cost Health Canada $10 million. Could you explain to me what that $10 million expenditure consists of?

[English]

Dr. Paterson: It consists of a variety of initiatives, ranging from regulatory to public information, and also additional research that we'd have to do.

If you'd like more information on the specific initiatives, I could ask my colleague Diane to give you that information.

[Translation]

Ms Diane Jacovella (Manager, Office of Alcohol, Drug and Dependency Issues, Department of Health): This refers to prevention campaigns that would be conducted in order to increase public awareness of the dangers and harmful effects of alcohol. It also refers to money invested by the alcoholic beverage industry which, if they had to pay more for labelling, could decide not to conduct awareness campaigns, as the brewers have done in the past.

Ms Picard: Thank you very much.

[English]

The Chair: That begs another question, but anyway -

Dr. Hill.

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Mr. Hill: You've mentioned a drop of some 5% of alcohol consumption in Canada over the span of time since the U.S. brought in its labels. What has happened in the U.S.?

Dr. Paterson: We don't have the exact statistics available from the United States for the reduction in deaths. We could get them to you at a later date. What we can say is that the evaluation of the U.S. labelling is ambiguous or inconclusive. The population most impacted and aware of it was the heavy drinkers, the people who drank more than normal. They were certainly more aware of it, but whether they actually reduced drinking is debatable.

Really, more research is needed on the effectiveness of the labelling program in the States. But on your specific question, I certainly can't give you a specific answer at this time, and I don't think any of my colleagues can, but we will look into that and provide it to the committee.

Mr. Hill: Just so you're sure what I'm asking for, you've reported that Canadian consumption has dropped by 5.4%. Specifically, the number of people drinking has reduced by 5.4%. Of course this would be very interesting if in the U.S. there has been a similar reduction. It would say to me there has been a relatively small effect from labelling. If the numbers of people in the States have reduced more than 5.4%, I'd love to know that.

You're so specific about the Canadian experience. Do you have any idea about the U.S. experience?

Ms Jacovella: At this point I couldn't give you any U.S. data. I think what we're referring to is that Canada did two national surveys on alcohol and the drugs issue, one in 1989 and one in 1994, and the results that came out just this fall showed the 5.4% reduction in alcohol consumption in Canada. That is talking about the mainstream population, which is usually the population reached by those types of awareness messages. I think the point was that this reduction has happened even without warning labels on bottles, at present.

Mr. Hill: My second question. You mentioned ``Australia's standard drink labelling''. I don't understand what that means.

Ms Jacovella: The Australian government, rather than moving towards one label, in December 1995, if I'm not mistaken, adopted one standard drink. When they explored the issue of warning labels, or of trying to achieve the same results of raising awareness of the harm caused by alcohol abuse, they felt standard drinks... meaning if you have a bottle of wine, based on what they consider a standard drink in Australia, how many servings are in a bottle of wine? They tell people how much, and it's accompanied by an educational campaign that would tell them, if you're a man, you should drink no more than so many drinks per week or per day. For women it's different. Therefore people could look at what they drink and see how much they drink.

For example, when you look at strong beer, it is more than one standard drink. Often people don't think about it. They don't look at the percentage of alcohol. So that was a way to inform people about the harm caused by alcohol abuse and be able to have responsible, low to moderate drinking practices.

Mr. Hill: When the health minister made his pronouncement that he wasn't all that keen on this, did that have any effect on your...? I did notice you underlined ``principle'' here, quite distinctly. You support the ``principle'', underlined, of Bill C-222. It is interesting.

It does not make any difference to you?

The Chair: You have seen the minister's article?

Dr. Paterson: Yes. Obviously in this case we are consistent with the minister's position, and that's the way it should be. But our position has been consistent since before Mr. Dingwall took over his current responsibilities for this portfolio.

Ms Jacovella: There is one thing. Health Canada has been involved in leading Canada's drug strategy since 1987. We are really supportive of raising awareness about the abuse of alcohol and the harm it can cause to Canadians. We have been quite active in the last nine or ten years in this. I think the initial speech meant that we are supportive of the principles of informing Canadians about the risk associated with alcohol abuse.

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Mr. Hill: So really you're suggesting to me that you are leading the minister, rather than the minister leading you on this issue.

Dr. Paterson: No, I'd hate to suggest that. I think we're harmonized.

Mr. Scott: Very specifically, I would like to know this. You've been at this for nine or ten years. The part of this that has had the most impact on me in terms of the very limited time we've spent on this has had to do with the effects on pregnant women or women who might be pregnant.I knew about driving trucks around and stuff like that, but this part informed me more than the other. Let's say that.

If I'm of the opinion that what we really need to do is affect Canadians in the fashion that you, or the people who have presented, have affected me, which is to bring the awareness level up, then in a very specific way, I'm less of a target then someone who might be pregnant.

Has anyone been able to determine who the unaware target audience is? Is there any research that would tell me whom we have to tell about this, rather than just generally? Do we know who is affected by this? The last time I tried to pose a question, I think I sounded like I was trying to make socio-economic judgments as to who drinks. That's not my point. My point is on the question of awareness. Is there any evidence that would tell me who doesn't know, yet we should be telling them? I'm trying to judge whether this is the best way to tell them.

Dr. Paterson: I'll turn that question over to my colleague.

Ms Jacovella: I am not aware of any piece of research in terms of looking at who knows about the effect and who doesn't. I think you need some consistency of messages so that people really understand.

A good example is whether some alcohol is good or not. There are a lot of things in the media that are pushing in one direction with a lot of other statements. I think people need to know a consistent message. They need to know the facts. You especially need to know, because you still always have to do prevention awareness programs with youths, especially before they start drinking, so they understand what the harm can be.

There's also a lot of work that needs to be done in terms of health professionals when you're referring to FAS. I think one of the issues with FAS is that I'm not sure women don't know that it is harmful. I think they sometimes live in such difficult socio-economic situations that for them it's really difficult to stop drinking. They're drinking because of something else, underlying reasons. Just the awareness is not enough to help them stop drinking and change drinking practices. We need to look at the root causes of why they do it and at determinants of health.

Mr. Scott: I accept all of those things, but I think the labelling.... I accept all of the other things: it's a reminder, it adds to other more general programs, and all of those things.

But as a very simple exercise, as a matter of being the method by which we tell people who genuinely don't know the risks they're running, are there certain people in certain circumstances who have less access to that information today than others? And is this the best way to get that information to them? I need to know if there's been any research that deals specifically with that question.

I'm aware of the need to have medical professionals and the general population understand this and the impact, or what it will mean, when the general population knows this. Will it mean that public policy will reflect that awareness and so on? It's all of those things.

I'll tell you where this comes from. A woman appeared before our task force on healthy children. She said the problem was that it was good for her - that's what she said to us - but that she already knew. The parents of the kids with whom I'm dealing don't know this, and I'm not sure that this is going to tell them.

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It affected my thinking on this, so I'm trying to find out whether there is any reliable evidence to hold that up, or is that just anecdotal? I don't think it's diminished by being anecdotal either.

Ms Jacovella: I think you're raising a very important point. I think that's also a bit of our opinion. We need to do more research to know the best way to reach people, and the various groups of people. I guess we don't have that research. It's not available yet, but it would need to be done.

Mr. Scott: Could I request it be done? It has been so very fundamental to this discussion.

Dr. Paterson: Yes. As Diane was saying, we would support that. Obviously there is a limit to how much research you can do, so you'd have to target the priorities. But as Dr. Guilfoyle was saying, who should we be targeting?

There is a large segment of the Canadian population that is illiterate, so nice, well-written messages in English and French may not be hitting that key group. We've got to do more research on the best methods of reaching the various target groups, whether it's pregnant women, illiterate adults, youth, etc.

To a large extent, we have not done a lot of original research in Canada for various reasons. We've used research from the States, France, and other countries. So your point is very valid, and we'll certainly make note of it.

The Chair: I must move on to Mr. Szabo.

Mr. Szabo: Thank you. I have a few questions.

The first part mentions the ambiguous evidence of the effectiveness of warning labels in the U.S. Can you provide a list of - maybe you can tell me now - how many credible, bona fide studies indicate that there is evidence this is ineffective? Can you do that?

Ms Doris Cook (Health Policy and Information Directorate, Policy and Consultation Branch, Department of Health): We will provide you with the information and studies we have.

Mr. Szabo: Do you have any idea how many studies we're talking about? How many have been done? Is it five or ten?

Ms Cook: I can't honestly say.

Mr. Szabo: Okay.

Dr. Paterson: Mr. Szabo, I think our evidence suggests that the U.S. government has done about 15 over three years in terms of looking at the impact and effectiveness of the mandatory labelling.

Mr. Szabo: So you see from the results that generally they're just not effective at all, or they're just a little bit effective, or they're modestly effective, or whatever? If you're saying to me right now that the labels in the U.S., according to credible studies, have had absolutely no effect, please say so.

Dr. Paterson: No. I'll mention three points. One is that heavy drinkers, as I mentioned, were most aware, since they're obviously looking at the bottle more often than moderate or infrequent drinkers. However, they were found to be the least affected.

Second, since 1989, other drinking-and-driving campaigns have possibly influenced public awareness as much as or more than labelling.

The third point is that while moderate drinkers were most affected by labels, most alcohol risks are correlated with a number of heavy drinking occasions and alcohol dependence. Again, as my colleague Diane said, we're looking at some other deep-rooted issues in terms of dependency on drugs or alcohol, which labels won't cure.

Mr. Szabo: Thank you. You have laid out here four possible alternatives to labelling. The continuation of the FAS/FAE is, I guess, education awareness.

Dr. Paterson: Yes.

Mr. Szabo: There's the awareness program regarding youth and under-age drinking. There are the training programs on issues about health professionals on alcohol and other drugs. I assume that this is possibly some preventive or maybe some remedial... like an ARAI program. And the last one was awareness programs on impaired driving, which is awareness again. Your proposals, your suggestions, of more effective ways in the most part seem to pertain to improving awareness.

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You then concluded that labels aren't effective because they cannot be linked to behavioural changes. The criteria that you used to measure the effectiveness of labels was their ability to affect behaviour, yet what you're proposing is to continue with awareness. So it struck me immediately that there's a contradiction here.

Dr. Quirke, you also raised the issue of the case of Hollis v. Dow Corning, in which the courts basically said that if there was a warning label, their liability would have been mitigated. You've raised this for our attention because it's important for the industry to warn by appropriate means. That would mean labels are, or could be, one of the appropriate means. There may be other appropriate means, but I don't want to ask you about those either.

What I want to ask you about is something that I think goes to the heart of what's going on here, and that is that something has desperately changed, Madam Chair. I don't know what it is. On December 7 in the House of Commons, the Parliamentary Secretary to the Minister of Health spoke on this labelling bill, and I quote her last statement, from page 17418 of Hansard:

I hope everyone here will support the bill. We support it very strongly at Health Canada. We believe if we are ever to prevent the preventable diseases that create a great deal of tragedy in our lives, this is one sure step. We are already half way there. We do it for the United States. Let us do it for Canada.

Madam Chair - and the clerk has circulated it - I have been getting on my feet in the House of Commons daily to present petitions from Canadians in support of Bill C-222. The minister is responsible to respond to these things. He signed them, the statement is here, and the statement says -

The Chair: When is the date of the statement?

Mr. Szabo: I went to the House of Commons this morning to look in my desk to get the most recent one that they put in yesterday. It's my petition that I submitted on March 28. You have one that is just part of that. The most recent one that I have received from them is dated March 28, 1996, and it says:

The Minister of Health supports the current legislative amendment (Bill C-222), a Private Member's initiative.... Bill C-222 was approved at Second Reading....

It was signed by the minister on March 28. The minister clearly supports no change.

You said to this committee on the record that your position today is consistent with the position that was held by Health Canada even before the current Minister of Health came to occupy that position. The honourable minister, Diane Marleau, came to me and told me, ``I'm supporting your labels.'' The Parliamentary Secretary to the Minister of Health said, ``We are supporting, and Health Canada is supporting, the interest of the petitions that have been received.'' Even yesterday, in the House of Commons, in that honourable chamber, the minister supported this bill.

So I have to ask you, sir, what has changed between the time this went in my desk last night and today when you have come before this committee?

Dr. Paterson: I don't think anything has changed, and I go back to the opening statement.I think it's consistent with what our minister said last week - that we support the principle of the bill. Nothing has changed in that regard. What we're looking at is a series of initiatives that could help produce better public policy for Canadians in the whole area of alcohol consumption, and better education about the effects of alcohol on the general population, as well as a specific target group.

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So, Mr. Szabo, I don't think there has been a fundamental shift. We're very consistent with what our minister has said. I haven't read the Hansard you refer to, but I would contend there is no fundamental shift. We support the bill in principle. It has always been said, and as officials of the department we continue to say that.

Mr. Szabo: There's a contradiction on the record between what you have said and what the parliamentary secretary said and what the signed statement of the Minister of Health says. We'll get to the bottom of that. We're not going to resolve it here.

I'm sorry. I must apologize now for getting a little agitated. I've worked on this for a year. I'm sorry, I'm just into it.

I have one last question, and I think this is critical, because in my view the only thing that's really changed is that this bill has a chance to pass and we have this lobby the MADD organization told us about - and how powerful they are - and it raises the spectre of what has happened. I don't know. I'm not going to speculate and I'm not going to make allegations. But you said also in your testimony that your position - and we'll check the record - on this matter of labelling is consistent with that of the Minister of Health, not that the Minister of Health represents the position of Health Canada, who is there to defend and protect the health needs of all Canadians.

So you have stated that whatever your position might have been, according to the record, once a new minister comes, your position changes for that minister. Can you tell this committee what qualifications, what new research, what evidence, what expertise the Minister of Health could bring to you to change your mind from supporting this bill to reducing it to support in principle, or in fact to change the position that was articulated before the change in cabinet?

Dr. Paterson: No, because - again, it might sound like a broken record - as I think my colleague has said, over the years, with the information we've gathered, we've maintained a fairly consistent position of wanting to gather more information on the effectiveness of labelling as a sole intervention versus, say, a targeted approach using a multiple set of criteria and initiatives. We've always supported the objective of the bill in principle, and nothing has changed in that regard.

Mr. Szabo: You're familiar with the U.S. labelling, etc., and you probably would concede it seems to have a variety of forms and probably would not rate very high in effectiveness of communicating a message. Is that fair to say?

Would you like to see the bottles again?

Dr. Paterson: Yes, I think that's fair to say.

Mr. Szabo: You'll agree with that? So the U.S. labels are not generally effective, or are not as effective as they could be, compared with something like this. If that is the case, if the labelling that's in the United States...and knowing the research on the table right now is only 1992 and 1993, and knowing I can show you research, if you'd like to see it, saying two-thirds of alcohol products in the United States didn't have the label until six months after implementation.... That means the current data is very brief. It's very difficult, I would think, for anybody to do research and somehow conclude long-term behavioural impacts, because the observation period is so very small in terms of the pure thing. Also, during that period education was going on, and so was all this other stuff.

Since you're not sure whether this is the most effective... how is it possible you have been able to determine that labelling is not effective when other things and other variables are going on at the same time? How can you attribute it to this or that? How can we say education is more important and labelling somehow isn't education? I would disagree with that. When things are going on, how is it that you can conclude that this would work and, using the same results, that labelling wouldn't or is not effective? This research data is basically speculative at best.

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So I ask you, what expectations do you have from the U.S. to support, and do you think that's going to change over the next five years in terms of your knowledge about what's going to happen in the States?

Dr. Paterson: I'm going to deflect your question to my colleague Diane, and then Ann would like to say something about freedom of speech implications.

Ms Jacovella: The only point I want to address is the point you raise on the research that has been done in the States. If they did new studies now, maybe they would show different results. What we're saying is before making a decision to go one way or the other, what Health Canada would like to do is look at the options and maybe look at a comprehensive approach. Maybe the results of further studies would say yes, this is the way to go, but the evidence is not there at this point.

I think Ann will talk about our legal system in Canada, which makes it difficult without the evidence.

Ms Ann Sunahara (Legal Adviser, Department of Justice): Unfortunately, there's a fundamental difference between the Canadian and American legal systems as they pertain to the right of commercial speech. In the United States the right of commercial speech is less protected by the U.S. Constitution than it is in Canada, as indicated by the Supreme Court in a recent case regarding tobacco.

This means that where you have, as here, a label going on a product that says something the producers of the product do not wish to say, they have a constitutional right not to say that unless it is attributed to the Government of Canada and unless the proper evidentiary basis has been laid to show it is the least intrusive means of infringing on their free speech. So the onus we have to meet legally in Canada is very much higher than the onus we have to meet in the United States.

I would also distinguish this from labels on things like hazardous products. The labels on hazardous products are not statements the manufacturers do not want to make. They want to make those statements. All we do in that situation is standardize the statement.

So I have to distinguish between the two situations and between the Canadian and the American on that basis, too.

The Chair: I'm going to have to cut this off. Both Mr. Szabo and Mr. Scott have to leave.

I have a great question for you, but it will have to wait.

I think Madame Picard has something else.

[Translation]

Ms Picard: A brief question.

You said that in the Hollis case, the Supreme Court of Canada had asked the industry to communicate warning messages appropriately and to incorporate them into advertising.

You seem to be saying that that was an interesting approach. Has Health Canada approached the industry to ask them to incorporate warnings such as ``moderation tastes better'' in their advertising, since we all know that advertising is very different from awareness programs?

I would look favourable on the approach contained in the Supreme Court decision when companies promote their products in a way that could contain a warning. The warning could refer to foetal alcohol syndrome or...

Have you started approaching the industries about this?

[English]

The Chair: We are going to lose our quorum here, and I have to get a motion approved, so please be very brief.

Dr. Paterson: That's a very good question. Yes, we're studying the implications of that decision in terms of our regulation-making processes. Have we developed a specific game plan to consult with the industry? Not yet.

The Chair: Thank you very much.

I'd just make a closing statement. We know alcohol abuse in this country costs us close to 1.5% of our GDP. That is $12 billion to $15 billion per year. That's what I've been told. We, as the federal government, collect $7 billion every year. That gives us cause for reflection. It's a very serious issue that we need to address.

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I want to thank you all very much for coming. We look forward to further consultations with you.

Dr. Paterson: Thank you, Madam Chairperson.

The Chair: Committee, please don't leave the table. We have a motion here.

Mr. Szabo: I'll move the motion.

The Chair: It's to approve an expenditure of $450 to Donna Wheway, who came to the committee from Vancouver. She had three children who had -

An hon. member: Question.

Motion agreed to

The Chair: The next meeting is on Tuesday, not Wednesday.

This meeting is adjourned.

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