Where you live in Canada may play a role in your risk of major diseases like cardiovascular disease, diabetes and cancer.
Researchers at McMaster University have identified trends linking
health and lifestyle factors like access to public transit, the variety
of fresh fruits and vegetables in grocery stores, the prices of popular
foods, the availability and prices of cigarettes and alcohol, and the
promotion, or lack thereof, of healthy foods in restaurants.
The study findings, based on detailed data collected across Canada’s 10 provinces, were published today in the journal Cities and Health. An interactive online map for public use showing the data by postal code is available at: http://cvcdcontextual.mcmaster.ca.
“We found there are significant differences in environmental factors
that may contribute to health, and that these differed between urban
and rural communities, as well as when we compared eastern with western,
and northern with southern communities,” said Russell de Souza, first
author of the study and assistant professor in the Department of Health
Research Methods, Evidence, and Impact at McMaster.
He is also a research associate at the Population Health Research Institute (PHRI) of McMaster and Hamilton Health Sciences.
“We believe that this information shows there are factors outside of
a person’s control that influence the individual’s health, and these
factors likely differ depending on where they live.”
The main findings of the study are:
- provincial and urban-rural differences exist in availability of
fruits and vegetables, and advertising differs between provinces more so
than between urban and rural communities;
- rural communities face higher food prices, are more subject to
seasonal variation in fruit and vegetable selection, and generally see
less promotion of healthy restaurant options and availability of
nutritional information at restaurants than urban communities;
- in-store advertising for sweet drinks, and junk food are more frequent than in-store advertisements for tobacco products;
- cigarette prices are lower and the variety of brands is greater
in urban than in rural tobacco stores; and are lowest in central
Canada, where there is both more in-store advertising for cigarettes and
signage prohibiting smoking in stores; and
- alcohol prices are lowest in Quebec.
More than 2,000 on-the-ground assessments conducted in all of the
provinces were collected by trained auditors between 2014 and 2016. The
assessment tool was adapted from the McMaster-led Prospective Urban and
Rural Epidemiological (PURE) study that simultaneously assesses multiple
contextual factors within communities and has been used
De Souza said the research was driven by concern about health trends in the nation.
“The rapid increase of overweight and obese Canadians and the
associated consequences, including hypertension and diabetes, is a major
health problem and threatens to halt the declines in cardiovascular
disease deaths that Canada has experienced in the past 30 years,” said
“Knowledge gaps exist regarding the impact of the built environment –
or the human-made physical surroundings – on how someone develops risk
factors like high blood pressure, and the variation of these built
environments across Canada by region and rurality.”
The researchers were unsurprised to find that the environmental
factor trends aligned with health outcomes tracked in other studies.
“Previous Canadian studies have shown that people living in the east
have a higher risk of developing heart disease than people living in
the west,” said de Souza.
“We also see people who live in rural environments tend to have poorer health than people who live in urban environments.
“This study helps us to understand what we call the ’causes of the
causes’ of diseases like cardiovascular disease. For example, what are
the factors that lead to the development of high blood pressure, which
can later lead to a stroke or high cholesterol, which later turns into a
De Souza said the researchers decided at the start of the study the
data would be presented in an online, interactive map to convey the
information from the community contextual health audits.
“We think presenting our data in this way offers a platform for
policy makers, public health professionals and community members to
collaborate to build healthier environments and fix the problems,” de
“By understanding how the built environment plays a role, we can
intervene both at an individual level, as well as at a community level.
It’s one thing for your doctor to tell you that you need to eat more
fruits and vegetables to lower your blood pressure, but what if your
grocery store prices are so high that you cannot afford them? Or if to
get to your grocery store, you have to drive for 30 minutes? If five to
10 servings of fruit and/or vegetables are recommended daily, we should
advocate for everyone to be able to afford and access those servings.”
The study was a component of the Canadian Alliance for Healthy
Hearts and Minds (CAHHM), led by Sonia Anand, professor of medicine at
McMaster, senior scientist of PHRI, and vascular medicine specialist at
Hamilton Health Sciences.
CAHHM is a multi-ethnic cohort study being conducted in Canada. The
study aims to understand the association of socio-environmental and
contextual factors, such as societal structure, activity, nutrition,
social and tobacco environments, and access to health services, in
relation to risk factors of cardiovascular and other chronic diseases.
“This study is unique because it will enable comparisons between
communities within a region, province, and across the country. Place
matters as our environment affects our health behaviours without our
realizing it,” said Anand, the Heart and Stroke Foundation / Michael G.
DeGroote Chair in Population Health Research McMaster.
“We are making these data available to other researchers and health
planners so they can further quantify the impact of the built
environment on health, and to help in the building of healthier
communities,” she added.
As for the best place to live in Canada’s 10 provinces based on
study results, de Souza said it depends on your health habits and
“I would want to live somewhere that makes it easiest to change any
behaviour that may be harming my health,” he said. “For example, if I
were a smoker, I would want to live in a place where it was hard for me
to get cigarettes. If I were having a difficult time eating healthy, I
would want to live somewhere where it was easy for me to walk to a
grocery store and buy affordable fresh fruits and vegetables.”
De Souza noted the three territories were not included in the study due to geographical limitations for the research team.
The CAHHM project is funded by Canadian Partnership Against Cancer,
Heart and Stroke Foundation of Canada, and the Canadian Institutes of
Health Research (CIHR) through the Canadian Urban Environmental Health
Anne Simard, chief mission and research officer of the Heart and
Stroke Foundation of Canada, said: “This study demonstrates that rural,
including northern and remote communities continue to face inequities
with respect to access to healthy food options and even nutrition
information in restaurants. This underscores the need for policies to
improve nutrition in these communities.”
Craig Earle, vice president of cancer control with the Canadian
Partnership Against Cancer, added: “The importance of these findings is
that they highlight disparities that contribute to different health
outcomes depending on where you live. There are things we can
collectively take action on today.”
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