Where you live can have a huge impact on your chances of developing diabetes, concludes a new three-year study of 140 Toronto neighbourhoods that has implications for all Canadians.
Poverty and immigration are key factors in developing adult onset, type 2 diabetes, which is associated with poor diets and excess weight, say researchers with Ontario's Institute for Clinical Evaluative Sciences (ICES) and St. Michael's Hospital.
Diabetes rates are highest in areas that have lower income levels, higher unemployment rates, higher proportion of visible minorities and higher immigration rates, the study found.
But those areas are not necessarily in the city's downtown core. Rather, the areas with the highest rates of diabetes tend to be found in Toronto's northern suburban areas, where many have moved in a bid to find affordable housing. It is in these northern suburbs where there are fewer amenities within walking distance, fewer fruit and vegetable stores, poorer access to public transit and greater car dependency.
The study found diabetes rates were highest in the northwest and northeast ends of Toronto, such as Humber Summit and the Malvern area of Scarborough. These neighbourhoods also have high proportions of visible minorities and recent immigrants.
Wealthy areas in the centre of the city, such as Rosedale, on the other hand, have low diabetes rates. These areas also tended to have fewer visible minority residents and recent immigrants.
High-risk downtown neighbourhoods, such as Regent Park and Parkdale, actually have lower diabetes rates than expected, most likely because of the ability to walk to services, better access to healthy foods, recreational centres and public transit, the authors say.
Co-lead author, endocrinologist and ICES Adjunct Scientist, Dr. Gillian Booth says the problem with modern suburban life is that residents tend to spend too much time in their cars or inside their houses watching TV.
"The opportunity to walk to the corner store and take children to parks without having to drive should be available to all Canadians in the neighbourhoods where they live," she says.
"The consequences of today's epidemic will take a toll on our health for many years. We are starting to realize how bad the problem is. We need societal changes and the good news is - it's not too late."
The study authors offer the following recommendations:
- Change planning, development and zoning practices to reduce urban sprawl, increase residential density and promote mixed land use.
- Provide incentives for stores selling fresh produce and other services to move into high-need areas.
- Increase access to public transit.
The study lead author, Dr. Rick Glazier, senior ICES Scientist and a family physician at St. Michael's Hospital says obesity and its consequences, which include type 2 diabetes "is the tobacco of the 21st century."
"Just like we did with tobacco, we need to take a multi-faceted approach to address the diabetes epidemic," he says. "We need to motivate behavior and change environments to help people make better choices at school, at work and particularly in the neighbourhoods they live in. When we plan and redevelop neighbourhoods, there is an opportunity to make these healthier, especially for those who belong to disadvantaged groups.
"It's a wake up call for all of us."
