Toronto Star

Being poor can be deadly, report on fatal disease says
Doctor says lifestyles let poor fall prey to dangerous ailments

   Prithi Yelaja

MEDICAL REPORTER
Being poor is a major cause of cardiovascular
disease in Canada, according to a new report.

A report commissioned by the North York Heart Health Network, a coalition of
45 community agencies, found almost one-quarter of premature deaths prior to
age 75 in Canada are attributable to income differences.

And the one disease responsible for the largest share - 22 per cent - of the gap
in death rates is heart disease, says the report, Inequality is Bad for our
Hearts,
which was released at Toronto city hall yesterday.

"These findings are frightening and very disturbing. The message is: don't be
poor
and live in a poor neighbourhood because you're going to end up in the cardiac
ward of the hospital," said Dennis Raphael, the report's lead author and a
professor of public policy and management at York University.

If all Canadians died of heart disease as infrequently as those in the
wealthiest
one-fifth of neighbourhoods, there would be 6,366 fewer Canadians dead each
year from cardiovascular disease, the report found.

Raphael arrived at the conclusions based on Statistics Canada data and a review
of international research over the last 20 years. While exact ly how
cardiovascular
disease results from low income are not yet clear, Raphael said excessive
stress,
material deprivation and the adoption of unhealthy habits such as smoking are
believed to be play a role.

What's more, Dr. Rosana Pellizzari, a Toronto family physician who serves a
predominantly low-income clientele, says Canadian society's current approach on
preventing heart disease may not be reaching poor people.

Our emphasis on modifying medical and lifestyle risk factors, such as tobacco
use, physical inactivity and high-fat diets has limited effect with those with
low
incomes, said Pellizzari, who practises at the Davenport-Perth community health
centre.

"We put too much hope on a lifestyle-based approach, which is a middle-class
approach. It's not the reality of poor people," said Pellizzari. "They don't
know
how they're going to pay the rent or feed their children, so who cares about
five
to 10 servings of fruits and vegetables a day?"

Community health centres that treat broader health-related issues facing a
particular neighbourhood as well as individual patients, are one way to tackle
the
problem, said Pellizzari.

Davenport-Perth, for example, runs employment workshops for its patients, she
said. The South Riverdale community health centre conducted a study into local
lead toxicity, while its Regent Park counterpart runs workshops on violence
prevention.

"A family doctor working alone in an office doesn't have that mandate," said
Pellizzari.

Raphael added that even poverty very early in life has lifelong implications for
heart disease.

A recent study in the British Medical Journal showed that low birth weight - far
more common among children in poor families - and low weight and height at
ages one and three were reliable predictors of heart disease among adults aged
45
to 54.

"It's clear that if you're poor as a child, you have a significant
cardiovascular risk
that carries on, regardless of your life circumstances," said Raphael.