Canada's health ministers gathered this week, issued ominous warnings about child obesity, issued yet another "framework for action," but understandably avoided the crunch problem: the two boxes.
A population of tubbies, such as Canadians, can't be explained by one factor alone. And sure enough, the ministers identified all the obvious and easy ones. They left aside, however, television and the computer.
Earlier this year, Ipsos Reid reported that those Canadians who go online - and that would be the large majority now - spend 18.1 hours a week compared with 16.9 hours watching TV.
Being online these days could mean checking something on a BlackBerry or an iPhone while walking down the street, rather than being plunked in front of a computer. But even allowing for new ways of going online, any way you put the two screen times of computer and TV together, you get a whopping amount of inert physical activity - about five hours a day.
Health ministers barely mentioned "screen time" in their brief report, for the obvious reason that there's nothing they can do about this strong societal preference. Add the two screens to the automobile - another indispensable part of modern society - and you have factors over which the best-intentioned politicians in the world have no control. Add something else - glaring income disparities - near the top of the list of factors that lead to being overweight and in bad health. Then ask which government today is prepared to make an assault on inequality.
We are - make no mistake about it - a nation of tubbies, as Statistics Canada described in detail earlier this year. According to the first findings of the Canadian Health Measures Survey - what government in its right mind wants to tamper with Statscan's ability to collect the best data? - "between 1981 and 2009, fitness levels of Canadian children and youth, as well as those of adults, declined significantly."
Thirty-seven per cent of the adult population is overweight, and 24 per cent is obese. Using body mass index as a measurement, Statscan reported that "Canadian adults have become heavier over the past 25 years." They became heavier not because they've become taller, as they have, or more muscular, but because the share of their total body mass given over to fat increased.
The tubby problem starts early. Fitness levels for children and youth declined from 1981 to 2009. About a quarter of kids between 2 and 17 are overweight or obese, but the older you get, the more likely you are to be overweight or obese. Aboriginal kids, of course, are in even worse shape, a function in part of their relative economic deprivation, among other factors.
A tubby population leads to all sorts of health problems, and all sorts of health problems lead to costs for the health-care system. That's why the ministers, in publishing a "declaration on prevention and promotion," said health promotion was "necessary to the sustainability of the system."
"Sustainability" is another way of saying: Find the money at current tax rates to keep the system going. Every province is struggling with the increases in health-care costs, and making everyone healthier sounds like a sensible thing to do. And it is, as long as everyone realizes that, with the best will in the world and the most energetic government policies imaginable, there are those factors (the boxes and the car) over which governments have no control.
Changing attitudes and behaviour takes time - decades, in fact. Consider smoking. Rates of smoking have fallen to 18 per cent, a huge improvement over a quarter of a century. The lower rates pay off in individual health and decreased costs for the health-care system. (Cynics reply that, since smokers die earlier, they save the system money.) But it took decades to wrestle the rate to 18 per cent, with governments using every tool available. And in Nunavut, the constituency of the federal health minister, the smoking rate is an astronomical 72 per cent for reasons that are apparently way beyond the ability of governments to influence.
Canadians who think, therefore, that the way out of governments' funding dilemmas over health care lies in making us all healthier fast are engaging in wishful thinking at best, deliberate avoidance of fiscal facts at worst. Yes, absolutely, there are a myriad of policies governments could adopt in schools, urban planning, early childhood development, health promotion, publicity, even sin taxes on soft drinks or fatty foods. (Just try that one and wait for the howls.)
Some of these steps are now being taken, but many critical factors lie in the hands of parents over whom governments have little influence, in ingrained behavioural preferences that governments can only exhort people to adjust or abandon, in the layout of cities and suburbs that took decades to congeal into their current shapes, and in the five hours of daily attachment to those fascinating, inert boxes that are the most popular sources of amusement and information today.