Implementing powerful health promotion strategies can help save lives of Canadians

Groundbreaking NYC public health pioneer prescribes remedy for Canada's health woes

Canada can save lives by implementing powerful health promotion strategies, says Dr. Thomas Farley, the trail-blazing commissioner of the New York City (NYC) department of health.

Dr. Farley, who will deliver the Heart and Stroke Foundation of Canada Lecture at the Canadian Cardiovascular Congress today, led the groundbreaking public policy initiatives in NYC.

Successes in NYC include one of the first laws to prohibit smoking in public spaces in North America, a restaurant trans-fat ban, mandating menu board calorie labelling, implementing healthy community design initiatives that support physical activity and the introduction of regulations - pending legal challenge - aiming to limit the serving sizes of sugar-sweetened beverages.

His mission: to cement the path for citizens to live longer, healthy lives by making healthy choices easier. He calls it 'healthscaping,' creating an environment where good health blooms.

"Healthy environments open the door to healthy choices," says Heart and Stroke Foundation president Bobbe Wood. "Adapting the NYC model in Canada could help us make real strides in preventing and reducing our rates of chronic disease. This is especially critical given the aging of our population, high rates of obesity and the increase in the consumption of processed foods."

Dr. Farley says it is well known what people can do to prevent heart disease: get active; know and control cholesterol levels; follow a healthy diet; know and control blood pressure; achieve and maintain a healthy weight; manage diabetes; be tobacco free."

"The challenge is that these behaviours are influenced by the modern environments where we live," says Dr. Farley. "The solution is to change those environments to promote health by making healthy choices easier."

He adds that no single measure alone will make the difference. "We need a combination, a multi-pronged approach. The earlier we can intervene and take steps to improve health, the more people who can reap the benefits of a longer life expectancy and healthier lives."

Ways to do this, he says, are through initiatives that allow people to be active, follow healthy diets, achieve and maintain healthy weights and be tobacco free:

• Design neighbourhoods where healthy foods are easily accessible and that increase opportunities for physical activity
• Reduce consumption of unhealthy foods
• Create health-promotion laws and policies (e.g., smoke-free air policies )
• Make cigarettes less accessible and more expensive
• Run hard-hitting media campaigns

The success of the sometimes controversial NYC health programs are well documented:

• Since the initiatives were introduced, deaths from heart disease decreased by nearly 40 per cent (from 2002 to 2011)
• Life expectancy increased faster in NYC than nationally. Between 2001 and 2010, the life expectancy of New Yorkers rose by 36 months to a life expectancy of 80.9 years, while the national average rose by 21.6 months to 78.7 years
• Obesity rates for children declined
• NYC smoking rates went from a three year average of 21.7 per cent in 2002 to 14.8 per cent in 2011
• There was a 21 per cent decline in the number of New Yorkers drinking sugar-sweetened beverages between 2007 and 2012

"Population-based disease prevention is the most powerful and efficient tool to improve and sustain the health of Canadians," says Wood. "The Heart and Stroke Foundation shares the vision of improving the health of our citizens through enlightened public policy. This is a proven road map for longer, healthier lives."

The resulting impact on the health and lives of Canadians would be immense: every seven minutes in Canada, someone dies of heart disease or stroke; these are two of the three leading causes of death. They are our leading cause of hospitalization accounting for 16.9 per cent of total hospitalizations. And millions of Canadians are living with heart disease or the effects of stroke.

The potential cost-savings to our economy are also substantial.

The impact of Canadians' risk factors on our economy

Heart disease and stroke alone cost the Canadian economy $20.9 billion every year in physician services, hospital costs, lost wages and decreased productivity.  In 2020 total costs are expected to reach to $28.3 billion.

"Communities that are designed to help shape healthy behaviours play an important part in improving health and increasing life spans in Canada," says Wood. "We should take a very close look at the potential that public health strategies could have in reduced health care costs and in improved health here in Canada."

She adds that such public health strategies could also accelerate the progress of the Heart and Stroke Foundation's goal to reduce Canadians' rate of death from heart disease and stroke by 25 per cent by 2020.

Canada's heart check-up from the Heart and Stroke Foundation:

Smoke-free spaces: Canada has 'gold standard' smoke-free legislation in public places and workplaces at the federal, provincial and/or municipal level. Smoke-free efforts should now focus on outdoor places (restaurant patios, beaches, parks, outdoor sporting stadiums, etc).

Trans fat bans: In 2009 the federal government implemented a trans fat monitoring mechanism over a two year period. This action, in combination with HSF advocacy and public awareness efforts led to a 60 per cent reduction in trans fat consumption in Canada. Canada remains above the WHO recommended level. We believe federal regulations should be implemented to get below the WHO target.

Calorie and sodium labelling on overhead menu boards: To date no jurisdiction has adopted the required legislation/regulations, although the Ontario government is proposing to do just that. The Heart and Stroke Foundation will join other Canadian advocates calling for improved nutrition labeling in restaurants, including calorie/sodium labeling on overhead menu boards and more fulsome labeling in table menus.

Sugar-sweetened beverage taxation and portion size regulations: No Canadian jurisdiction has adopted taxes or regulations of this type. The Foundation encourages Canadian municipalities to take action.

Community design: There has been growing momentum across Canada to invest in health-promoting community infrastructure and related policies.

The Heat and Stroke Foundation calls on governments in Canada to:

• Address the consumption of sugar-sweetened beverages, e.g., through public awareness campaigns, tax policy, sales bans in schools and recreational facilities and the elimination of super-sized servings in restaurants
• Continue to implement outdoor smoke-free spaces
• Consider improving nutrition labelling, including the development of guidelines for nutrition logo labelling programs and improved calorie and sodium labelling in restaurants
• Improving policies, programs and funding infrastructure that can facilitate healthy community design
• Introducing restrictions on the marketing of unhealthy foods and beverages to children
• Provide architects and urban designers with strategies for creating activity-promoting buildings, streets, urban spaces

HSF calls on Canadians to:

• Make their health a priority
• Talk to their health care provider about their risks and things they can do to reduce personal risk
• Adopt healthy behaviours: manage their diet, be physically active and smoke free and avoid excessive alcohol consumption and stress
• Advocate for healthy public policies so they and their families can live, work and play in a healthy environment
• Take the free Heart&Stroke Risk Assessment to get a personalized risk assessment and get tips and tools to lower their risk, at makehealthlast.ca