Megan Bosworth believes that to stay well, “you have to take control of your health.” In November, 1994, she did exactly that. Feeling unwell, she wondered whether the cause might be a lump in her right breast that a doctor had assured her a few years earlier was not a problem. She demanded a mammogram and later underwent a biopsy, which confirmed her fears—the lump was malignant. Surgery to remove it, followed by chemotherapy and radiation, left Bosworth, 50, apparendy free of cancer—and fired by a new determination to look after her health. Aiming for “a more balanced way of life,” she and her husband, John, who restores vintage cars for a living, moved from a village outside Toronto to a farm about 125 km northwest of the city. There,
Bosworth works off stress every day by riding horseback for about an hour and a half. At work, she makes a point of taking lunchtime walks. “I try to be as active as I can,” says Bosworth. “I watch my diet and avoid coffee and fatty foods. Staying healthy is a driving force in almost everything I do.”
Bosworth says that her job as office administrator for the health services department in York region, north of Toronto, has intensified her awareness of health. But experts say that Toronto and the neighbouring regions ofYork-Simcoe (including Markham and Richmond Hill) and Halton-Peel (Mississauga, Brampton, Oakville and Burlington) have a high proportion of health-conscious citizens in all walks of life.
That, they add, is one important reason the area generally shows excellent results in the Macleans Health Report survey of 51 Canadian health regions. According to the Statistics Canada data in the survey, the sprawling region, bustling with newly arrived immigrants, economic growth and new housing projects, has above-average life expectancy and below-norm death rates from the three main causes: cancer, heart failure and respiratory disease.
Overall, the region ranks above the national average in important socioeconomic determinants of health: income, numbers of high-school and post-secondary graduates, and employment rates, and below average in the proportion of low-income earners in the population. The slight exception is Toronto itself, where, says Dr. Sheela Basrur, the city’s medical officer of health, “the socioeconomic determinants of health are not so good—we have a disproportionate number of poorly educated and low-income people.” Although the full results for Canada’s largest city place it among the healthiest communities, it ranks above the national average in the number of babies with low birth weight—a condition that often leads to poor health later in life.
Still, Toronto, like the regions beside it, benefits from having a high proportion of well-educated citizens dedicated to healthy lifestyles. Typical of the breed is Brandon Marks, a 26-year-old Torontonian with a degree in chemical engineering who currently devotes his life to rock climbing. Marks, who has pursued his interest around North America and Europe, is an instructor at a Toronto climbing club. “Staying fit,” he says, “is an important part of my life. I’m healthy and I’m in good shape, „ and I intend to stay that way.” I The combination of a gener-
1 ally health-conscious populace % in an area rich in medical serI vices pays off in the statistics
Life expectancy in the largest city ranks above the national average
for heart disease and cancer—two of the leading causes of death among Canadians. Southern Ontarians with heart problems benefit from having relatively easy access to specialists, says Dr. Thomas Rebane, head of cardiology at the Trillium Health Centre, which has sites in west-end Toronto and Mississauga. But just as important is the fact that, because of better education and income, the majority of people in the region are likely to be aware of major risk factors for heart disease, such as a poor diet, lack of exercise— and smoking. “By the time patients see me,” says Rebane, “they know they should have quit smoking. That doesn’t mean they all have, but they know they should.”
When it comes to cancer, Dr. Richard Schabas, head of preventive oncology at Cancer Care Ontario, has a different explanation for the lower incidence and mortality rates in the Toronto region. High standards of living and educational levels make a difference, he says. But so does the concentration of new arrivals from other countries, who made up nearly half the population of Toronto in 1996. “It’s the healthy migrant effect,” says Schabas. “People from the Far East and some European countries have lower cancer rates, especially for breast, colorectal and prostate cancer.”
As bright as things look in the region, public-health experts have nagging concerns for the future. They cite, for example, the formidable needs of a growing population of older residents, widening income inequalities, a small but troubling increase in cases of tuberculosis and some other infectious diseases, and the scarcity of some types of physicians. Dr. Bob Nosai, medical officer of health for the Halton region, west of Toronto, is also concerned about worsening traffic. “That increases stress levels and cuts into leisure time,” he says, “while the growing number of vehicles affects air quality.” York region’s medical officer of health, Dr. Helena Jaczek, also has forebodings. “People are working longer hours to make ends meet,” she says. “A lot of people are not getting enough exercise, and most people living in the region are eating too much fat and not enough fibre. These things can affect disease and death rates 20 years from now.” The experts’ fears suggest that unless the trend can be reversed, risky lifestyles and environmental hazards could someday undermine the region’s currendy enviable status of health. E3
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