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Immigration, poverty + postal code = diabetes epidemic


It’s being called the 21st century epidemic. Diabetes is growing and Toronto is losing control over the disease.Home to some of the greatest extremes of neighbourhood wealth and poverty in the country, where you live in Toronto makes a difference in the likelihood that you’ll develop diabetes. Here’s why.

In a three-year comprehensive study of 140 Toronto neighbourhoods by Ontario’s Institute for Clinical Evaluative Sciences (ICES) and St. Michael’s Hospital, researchers found that poverty and immigration are key factors in developing type 2 diabetes. The first Canadian study of its kind, it examines the role neighbourhoods play in the diabetes epidemic. Lead author, Dr. Rick Glazier, senior ICES scientist and a family physician at St. Michael’s Hospital says, “there has been a dramatic 69 per cent rise in diabetes over the last decade and obesity is contributing to the onset of the disease. The implications are not only a burden on our health-care system, but the disease reduces life expectancy by about 15 years. This means children may not live as long as their parents. Modern life is taking a toll on our health and we must change how we live. That is why neighbourhoods matter and play a crucial role in the health of future generations.”

The ICES and SMH study, Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto – ICES Atlas, examines the following factors related to diabetes prevention and control in Toronto: population density, service density and dispersion, immigration, socioeconomic status, ethnic composition, crime rates, car ownership, access to healthy and unhealthy food, opportunities for physical activity and access to healthcare and its relationship to diabetes.

From a societal standpoint, here’s the bad news:

  • Diabetes rates are highest in areas that have lower income levels, higher unemployment rates, higher proportion of visible minorities and higher immigration rates.
  • Visible minorities, including people of South and East Asian, Afro-Caribbean and Hispanic descent, have a greater disposition to diabetes than persons of European descent.
  • Areas with high rates of diabetes tend to be found outside of Toronto’s downtown core, in suburban areas, where there is reduced access to healthy resources such as fruit and vegetable stores and where “activity friendliness” is lower (e.g. fewer amenities within walking distance, poorer access to public transit, greater car dependency).
  • The top three affected areas with high diabetes rates in Toronto are: Humber Summit with the highest rate of diabetes and the least healthy resources, followed by Malvern and then Keelesdale–Eglinton West.

The ICES and SMH study also found that neighbourhoods are affected differently:

  • Wealthy areas such as Rosedale have low diabetes rates, regardless of the level of access to healthy resources or activity friendliness.
  • Downtown high risk areas such as Regent Park and Parkdale have lower diabetes rates than expected, most likely because of the ability to walk to services, better access to healthy foods, recreational centers and public transit.

Co-lead author, SMH endocrinologist and ICES adjunct scientist, Dr. Gillian Booth says, “the flip side of modern conveniences is the fact that one in two Canadians are now overweight. We jump into cars, children watch television and play video games too much, we work longer hours and pick up prepared foods in larger portion sizes. It is critical that we find ways to incorporate physical activity and healthy eating into our daily life, but that’s only one part of the solution. 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. 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.”

As obesity rates increase and Canada’s population ages, as many as four million Canadians will be affected by type 2 diabetes, causing a dramatic increase in mortality by the year 2010. Placing a huge burden on the healthcare system and costing $8 billion annually, diabetes, a leading cause of blindness, kidney disease, heart and circulatory problems, can be prevented and controlled through activity, diet and medication. Most cases occur in people over 40, but experts are seeing children affected as young as 10 years old.

Dr. Rick Glazier says that “obesity and its consequences, including diabetes, is the tobacco of the 21st century. Smoking is now down by almost half and, just like we did with tobacco, we need to take a multi-faceted approach to address the diabetes epidemic. 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. Some of the answers lie in urban planning, while public transit can also play a major role. It’s a wake up call for all of us.”

The study has the following recommendations: Invest in high-need communities to help reduce the risk of diabetes and improve the control of the disease in affected people. Such investments would enhance the overall health of residents living in those parts of the city. 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. For neighbourhoods requiring investments, policies should take into account the health needs of the local population and the existing availability of resources to promote healthier lifestyles. Reduce consumption of high-fat/high-calorie fast foods with policies promoting healthier food choices by consumers and healthier menu offerings by food retailers.

The complete study, Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto – ICES Atlas is available on our website.

Toronto neighbourhood profiles are included as an attachment to this release.

This study was conducted with funding support from BMO Financial Group.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

St. Michael’s Hospital is a large and vibrant Catholic teaching and research hospital in the heart of Toronto. Fully affiliated with the University of Toronto, St. Michael’s Hospital leads with innovation, and serves with compassion. Renowned for providing exceptional patient care, St. Michael’s Hospital is a regional trauma centre and downtown Toronto’s designated trauma centre for adults.


  • Julie Saccone
  • St. Michael's Hospital
  • 416-864-5047

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