Cover

Unhealthy habits take a lethal toll

Weight problems and smoking contribute to the high rate of heart disease in the huge, hard-to-service region around Sudbury

D’Arcy Jenish October 25 1999
Cover

Unhealthy habits take a lethal toll

Weight problems and smoking contribute to the high rate of heart disease in the huge, hard-to-service region around Sudbury

D’Arcy Jenish October 25 1999

Unhealthy habits take a lethal toll

Cover

Health Report

D’Arcy Jenish

On a typical day at the office, Sudbury cardiologist Dr. Ronald Baigrie sees 15 to 20 patients, most of them suffering from heart disease. His medical recommendations can vary greatly—anything from diagnostic testing to bypass surgery—but his message about lifestyle never changes. Most coronary ailments can be minimized, he says, through good diet, regular exercise and not smoking. This fall, he is using a novel approach to convey that message. He has erected a 2.5-by-3.5-m billboard beside a busy commercial strip and, with a blunt combination of words and images, is advising motorists to use their heads to save their hearts. “Ultimately,” he says, “the only way you’re going to get at this disease is through a major change in behaviour.”

Baigrie has no idea yet whether the billboard, which is costing him $1,000 a month, has had any effect since it went up on May 3. But there is no question he is hitting an appropriate audience. According to the Macleans Health Report’s first-ever comparison of the status of health in 17 communities across Canada, Sudbury and the surrounding medical district, a vast tract stretching from Sault Ste. Marie to the Quebec border and north to James Bay, has the highest death rate in the country from heart attack, angina, stroke and other circulatory diseases. Statistics Canada figures from 1996, the latest available data at the community level, show that 333.1 people per 100,000 population died of those diseases in the Sudbury district, strikingly more than the national figure of 267.5. “The medical profession has known for a long time that this area is a hot spot for heart disease,” says Dr. David Boyle, an anesthetist and chief of the medical staff at the Sudbury Regional Hospital. “We have a high incidence of suicide and cancers, as well.”

The Health Reports figures, collected and broken down by Statistics Canada and the Canadian Institute for Health Information, bear him out. At 14.7 per 100,000 population, the district’s suicide rate is above the na-

tional average of 13.3, although rates will vary considerably at the community level from year to year. As for cancers, the Sudbury region has the third-highest mortality rate of the 17 communities in the survey—220.9 per 100,000 population compared with 199.6 nationally. Lung cancer deaths among women in the region—47.2 per 100,000—are the highest in the country.

Medical professionals based in Sudbury, the regional treatment centre for heart disease and cancer, say lifestyle factors undeniably contribute to the high mortality figures. The Algoma-Cochrane-Manitoulin and Sudbury District Health Council, as it is officially known, has a population of434,000 living in urban, rural and truly remote settings scattered over 200,000 square kilometres of northeastern Ontario. “In general, income levels are lower here than in southern Ontario,” says Joseph de Mora, president and chief executive officer of the Sudbury Regional Hospital. “The rates of smoking are higher, and the population is more elderly and more rural.”

Reliable data on smoking, exercise and body weight—all risk factors for heart disease—can be found in an Ontario ministry of health study for 1996-1997. It showed that 27 per cent of the population aged 12 and over in Sudbury and Manitoulin smoked daily, compared with 21 per cent of Ontario residents as a whole. Smoking was far more prevalent among low-income workers (37 per cent) than those in the top pay brackets ( 19 per cent). The survey also revealed that 35 per cent of those who reside in Sudbury and Manitoulin were overweight, according to medically acceptable height-weight ratios, compared with 28 per cent of the population provincially.

In his busy practice, Baigrie sees many patients who have developed heart disease through lifestyle choices—fatty diets, sedentary habits or smoking. He is also encountering a starding number of younger patients between the ages of 40 and 50. Many of them display symptoms of atherosclerosis, a hardening and blocking of the arteries due to a buildup of

HEART FAILURE Deaths from heart attack, angina, stroke and other circulatory disease, per 100,000 population in health regions in 1996

Weight problems and smoking contribute to the high rate of heart disease in the huge, hard-toservice region around Sudbury

plaque, which, in severe cases, can be relieved only through coronary bypass surgery. “It doesn’t surprise me that people in their 70s or 80s demonstrate complications from atherosclerosis,” says Baigrie, “but at age 40 or 50, it’s premature and shouldn’t be happening. We’re seeing a lot of it.”

He spends many hours counselling patients to adopt healthier lifestyles—a repetitive and sometimes exasperating task. “One thing that bothers me immensely is when a patient still smokes half a pack a day,” he says. “People are always coming in here and saying, ‘I know you’re going to give me hell for smoking.’ ” Baigrie now directs his efforts to a potentially more receptive audience—elementary school students. At least once a month, he visits classrooms and encourages youngsters to avoid the risky habits, including smoking and a junk-food diet, often acquired as teenagers.

Lifestyle is only one factor in the high mortality rate from heart disease in Sudbury and the surrounding district. Health-care professionals insist that their region suffers from a lack of resources. The Sudbury district, in fact, ranked last in a comparison of health-care services available in 16 major communities across Canada, published last June in a Macleans Health Report. Many of the outlying communities do not have enough general practitioners—residents of Kirkland Lake (population 9,900) learned recently that they are about to lose the only physician in their community who delivers babies. And Sudbury itself has a shortage of obstetri-

dans, plastic surgeons and dermatologists among other specialists. Doctors say colleagues often become run down from exhaustion. Many have left the region for large urban centres.

The sheer size of the region means that many patients put off seeking help until their disease is dangerously advanced, simply because of the distance they must travel. “On Manitoulin Island,” says Boyle, “some people travel 150 km to get to a 20-bed hospital and another 150 km to get to a specialist.” Adds Baigrie: “You can get a call from a physician who has a patient in urgent need of treatment. But he’s from Smooth Rock Falls, and it’s 2 */2 hours away by air.” The shortage of doctors and medical facilities is I nothing new for longtime Sudbury residents, including Mayor Jim Gordon. “For years and years and years, Northern Ontario has had just one of everything medical—one specialist of any kind, you name it,” says Gordon. “We need more money to put into health promotion.” But the 62-year-old politician is quick to defend his home town. Heart disease develops slowly over several decades, he says, concluding that the high mortality rates in 1996 reflect the civic culture and attitudes of the 1960s and 1970s, when Sudbury was a blue-collar mining town.

The gigantic smokestack which soars 375 m above Inco’s Big Nickel Mine and the adjoining smelting and refining facilities still dominates the city’s skyline. But Sudbury is now home to many manufacturers, burgeoning high-tech industries, a university, regional health facilities and extensive shopping and entertainment services. And contrary to its popular image, it is a green city, thanks to the three million trees planted under a reforestation program launched in the mid-1970s. “This used to be a mining community where men worked hard and lived hard,” says Gordon. “I’m quite confident that, with the efforts we are now putting into health promotion, if you look at people here in 20 or 30 years you won’t find the same rate of cardiovascular disease, or cancer.” Maybe, but for now that remains a goal. The reality is much grimmer. CD