Healthy choices affected by location

Where a person lives in Canada may affect their ability to make healthy choices due to a significant difference in environmental factors such the price and availability of fresh fruits and vegetables in their community, a study suggests.

The study led by McMaster University looked at 2,074 communities in all 10 provinces to identify a standard set of elements that could affect residents' ability to practice a healthy lifestyle in effort to mitigate the risk of developing conditions such as cardiovascular disease, diabetes or certain cancers.

The researchers have listed those factors on an interactive online map based on postal codes, which will allow individuals to check the status of their own community and to compare it to others.

"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 lead author Russell de Souza, an assistant professor in McMaster's department of Health Research Methods, Evidence and Impact.

"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,'' said de Souza, noting that the study did not include communities in Canada's three northern territories due to geographical limitations for the research team.

The study, published Tuesday in the journal Cities and Health, was based on data collected by on-the-ground auditors who assessed access to fresh produce in grocery stores, the availability and prices of cigarettes and alcohol, the promotion of healthy foods in restaurants, and access to public transit for each community between 2014 and 2016. Almost 84 per cent of those communities were urban.

"The goal was to profile communities across the country to see if there were differences in environmental factors that we think may influence disease risk,'' de Souza said Monday in an interview from Hamilton.

"For example, if we tell people to go and eat five to 10 fruits and vegetables a day, we wanted to know whether or not it was easy for people to access those fruits and vegetables in all communities across Canada, and whether or not there may be differences in the prices.''

Among the findings:

• There is generally lower access to fresh produce in rural grocery stores compared to urban, with the former marked by less variety, seasonal availability and higher prices.


• There tend to be fewer healthy meal options in restaurants based in rural communities than in city eateries.


• In-store advertising for sugar-sweetened drinks and junk food are more frequent in both rural and urban stores than for healthier food choices.


• Cigarette prices are lower and the variety of brands is greater in urban outlets than in rural tobacco stores; alcohol prices are lowest in Quebec.

Many previous studies have looked at geography-related determinants of health, including whether people living in neighbourhoods with fresh produce sold in stores within walking or cycling distance have a better overall health status than those where a vehicle is needed, or whether easier access to fast-food restaurants has a negative effect on a local population's health.

De Souza said this study differs because it used a standardized auditing tool to assess multiple factors in communities, with "apples compared to apples.''

"What we think we've been able to do is assess multiple aspects of this built environment and then use the data in a way that can help both public health people and city planners to make joint decisions to make healthy communities,'' he said, adding that having access to the data may encourage more people to advocate for healthier places to live.

"If you don't have enough information to make healthy choices, we think that may influence whether or not you develop certain conditions,'' said de Souza.

"So it sort of gets at taking some of the burden off the individuals and understanding that we live in communities which may or may not support healthy decisions.''

Lifestyles factors such as poor diet, lack of exercise and smoking can contribute to cardiovascular disease, Type 2 diabetes and some cancers.

The study is a component of the Canadian Alliance for Healthy Hearts and Minds led by McMaster's Dr. Sonia Anand, a multi-ethnic research project that aims to understand the link between socio-environmental factors and the risks 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,'' Anand said.

Anne Simard, the Heart and Stroke Foundation's chief mission and research officer, said the study shows that rural and remote communities "continue to face inequities with respect to access to healthy food options ... This underscores the need for policies to improve nutrition in these communities.''

As for the best place to live in Canada based on the study's findings, de Souza said it depends on which health behaviours are most important to an individual.

"For example, if you wanted to stop smoking, I'd not want to live somewhere where cigarettes are cheap and smoking is more permitted,'' he said. "If you need to eat more fruits and vegetables, I'd want to live somewhere where fruits and vegetables are available in large varieties and at a reasonable costs.

"I would want to live somewhere that makes it easiest to change any behaviour that may be harming my health.''