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 in the journal Cities and Health.

"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.

The main findings of the study are:

  1. provincial and urban-rural differences exist in the availability of fruits and vegetables, and advertising differs between provinces more so than between urban and rural communities;
  2. 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;
  3. in-store advertising for sweet drinks, and junk food are more frequent than in-store advertisements for tobacco products;
  4. 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
  5. 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 internationally.

Cardiovascular diseases 

"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 de Souza.

"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."

"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.

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."