This article was originally published in Maclean's Magazine on October 25, 1999
Vancouver Health Survey
Admittedly, 57-year-old Duff Waddell is a man who embraces excess. Practically every morning he is up at 5:30, pulling on his jogging shorts and gulping a glass of orange juice before heading off for a one-hour run. By 8:15, he is in the small office where he practises real estate law. He and his law partner, Frank Kaplan, own a small condominium near the office where they keep weights and gym equipment, so at lunchtime Waddell heads there to power up his deltoids and triceps. Then it's back to work until 5:30. In the evening, he may go kayaking or biking or head to a fitness club. "I don't think there's a day goes by when I don't work out," says the divorced father of two grown children. "It's always a fine balance with my job, which I love, but exercise is an essential part of my personality." While Waddell may be extreme in his mania for good muscle tone, he is not all that unusual in fitness-crazed VANCOUVER, where participation in jogging, skiing, mountain biking or in-line skating seems to be a prerequisite for residence.
The Vancouver way of life appears to be paying huge dividends. In the Maclean's Health Report's first-ever comparison of the state of health in 17 communities across the country, wholesome Vancouver posts many impressive results. Most significantly, the region officially known as the Vancouver-Richmond Health Board shows the lowest mortality rates from the two biggest killers in Canada - cancer and circulatory disease.
One reason cited by doctors is the city's affluence, due partly to the influx of wealthy Asian immigrants over the past decade. Socioeconomic status is a major indicator for good health. "The richer you are, the healthier you are," says family doctor John Mail. Of course, there are Vancouverites who have never set foot on a jogging path, and neighbourhoods where just getting by has a higher priority than a fitness regime. But the only real blemish on Vancouver's picture of health is in the economically depressed Downtown Eastside, where an epidemic of drug use has helped turn Vancouver into the AIDS-death capital of the nation.
Among the 17 communities in the survey, only one other stands out for its favourable results - particularly among its males. Toronto, widely derided for a notoriously stressful lifestyle, posts the lowest mortality rates in some key areas - lung cancer (and lung cancer specifically among men); respiratory disease (and respiratory disease among men); and circulatory diseases among men. Toronto's death rates for heart disease and stroke are also relatively low; for other cancers they are in the mid-range.
A key factor in both regions' successes is an educated, affluent population, says Dr. John Millar, vice-president of the Canadian Institute for Health Information, which gathered some of the information used in this survey. Social and economic determinants play a major role in well-being, and being well-educated - as Vancouverites and Torontonians generally are - "is a major driver of better health." While the quality of available medical care makes a difference, adds Millar, the former B.C. provincial health officer, "that's just part of the picture - the other factors are much more important in determining health."
In the key areas of lung cancer and respiratory diseases, says Millar, anti-tobacco campaigns and Toronto's 1988 ban on workplace smoking "have likely made a difference and helped to reduce mortality." As for the gender differences in Toronto, Millar notes that while national smoking rates for men have come down dramatically in the past 20 years, "a recent disturbing trend is an increase among young women." But he also cautions that trying to measure the health of Canadians on a regional basis "is a complex and difficult business." This Health Report offers a snapshot for the year 1996, says Millar, "but other trends will become clearer as we continue to break out comparative regional data in the years to come."
Vancouver meanwhile is, indeed, blessed with many amenities that seem to induce good health. Because snowfalls are rare, joggers and bikers can pursue their sport almost year-round, and children play outdoor soccer through the drizzle of the winter. More exercise means less risk of circulatory problems or cancer, doctors say. "Studies show that we are more physically active than other communities," says Dr. John Blatherwick, Vancouver-Richmond's medical health officer. "It's easier to be outside. Here, you only have to put on a raincoat in the winter. Everywhere else you have to bundle up." The downside to the temperate climate: incessant winter rain, which can induce depression among some residents. "We start to see patients in November," says Mail, "and it runs through until the daffodils come up."
But ocean breezes and the lack of major industry in the region keep the air fresh, and the tap water contains few additives. "The water here is rainfall that comes from the mountains, goes into the reservoir, and then right into the system," Blatherwick notes. "We don't have to add a lot of chlorine to it and so we don't have to worry about carcinogenic byproducts, which are said to cause bowel cancer."
The low death rates for cancer and heart disease are linked to other characteristics of British Columbians in general. "We have the country's lowest smoking rates and the lowest rates of obesity," says Barbara Kaminsky, chief executive officer of the B.C.-Yukon division of the Canadian Cancer Society. The B.C. smoking rate (24 per cent of the population 12 and over) is only marginally better than Ontario's. But both compare favourably to the highest smoking incidence - 32 per cent in Quebec. Since smoking is responsible for one-third of all cancer deaths, Vancouver's three-year-old ban on puffing in public places should continue to improve cancer rates, health officials say. There is also a widespread mammography program to detect breast cancer, offered even to women in their 40s, compared with most programs which start screening at 50.
Other factors combine to provide positive incentives to Vancouverites. Stanley Park and Pacific Spirit Park near the University of British Columbia are crisscrossed by bicycle and walking paths. "You're hard-pressed to find people here who don't exercise," says Katherine Lawson, a 34-year-old full-time mom who runs marathons and teaches aerobics. "People here would rather be outside, even if it's raining." Each of Vancouver's 23 neighbourhoods has its own community centre. And the nearby ocean beckons to Windsurfers and swimmers.
Cardiologist Ian Penn, 47, who regularly treks down to Jericho Beach to swim in the ocean with his 14-year-old daughter, Elisa, practises what he preaches to his patients about diet and exercise. "It would be hard if I was 240 lb. and I was telling them to cut down on their fat and lose weight," he jokes. The entire Penn clan, including mom Sandy Whitehouse, 42, Asher, 17, Daniel, 10, and Isaac, 7, are models of good health. Daniel emulates his father by participating in children's triathlons. Whitehouse, an expert skier, also jogs. The family often hikes through the mountains together or goes on bike rides through Pacific Spirit Park. "When I worked in Eastern Canada people would always ask me 'What do you do?'," recalls Ian. "Here people say, 'What do you like to do?' There is a difference here in lifestyle and focus."
Even local politicians can't seem to avoid the Vancouver penchant for exercise. Last August, B.C. Liberal Leader and former Vancouver mayor Gordon Campbell, his wife, Nancy, both 51, sons Geoffrey, 23, and Nicholas, 20, climbed the 5,895-m Mount Kilimanjaro, on the Kenya-Tanzania border, to raise money for the Alzheimer Society of British Columbia. To train, Campbell lost 25 lb. and took on the rigorous Grouse Grind, an 853-m ascent up Grouse Mountain, once a week. Nancy Campbell increased her half-hour daily run to one hour and accompanied her husband on various mountain walks. They've become keen hikers ever since. "Here, you can climb a different mountain every week," enthuses Campbell.
The school boards in Vancouver-Richmond abet the healthy lifestyle by offering outdoor camps on the Gulf Islands where kids from Grade 5 and up can go on vigorous hikes and bike rides. And the concern for children's health extends to the university level. The University of British Columbia was the first Canadian post-secondary institution to establish a practice in sports medicine in the late 1970s, headed by doctors Doug Clement and Jack Taunton. "Doctors began to recognize that exercise had an effect on health," says Clement. "And we've seen the adoption of this with great enthusiasm in Vancouver."
Clement, Taunton and others at UBC's sports medicine clinic also started a series of community runs. The biggest is the Vancouver Sun Run, founded in 1984, which drew more than 40,808 participants last year - the third largest 10-km race in the world. Now 66, Clement still runs it yearly, and despite a debilitating stroke in 1998 was able to finish this year's race in 53 minutes, only four minutes more than his pre-stroke time. There is even a contingent of participants over the age of 80, including Eleanore Cross-Spry, 85. She joined the run in the mid-1980s at the urging of her two sons, after the death of her first husband and the diagnosis that she had high blood pressure. Each year, by power-walking and jogging, she has managed to beat her own best, finishing last year's race in one hour and 27 minutes, a minute faster than the year before. "I've been first in my age category for the past six years," boasts Cross-Spry, with good reason. "I've even been faster than many 65-year-olds."
Cross-Spry says she is very conscious about what she eats, bulking up on fibre and eating fresh fish and chicken. That's common among Vancouverites, notes Mail. He thinks his patients generally eat better than people in Eastern Canada. "More vegetables, fewer meats," he says. "The so-called West Coast diet probably does mean something." Debra Boyle, president of Pro Organics Marketing Inc., which wholesales fresh organic produce across Canada, agrees. "I don't know whether people are more free-spirited here or open to change, but they are interested in eating better," Boyle says. She notes there are at least 20 companies in the Lower Mainland of British Columbia that deliver organic fruits and vegetables to your door, compared with three in Toronto. "Population-wise, Toronto is much bigger," Boyle says, "and we expect that's where our major business will be in the future. But here, in Vancouver, there's more awareness now about natural foods."
And about the value of leisure time. Statistics Canada numbers show B.C. workers paid by the hour spend 29 hours a week on the job, compared with the national average of 31.3. "People here tend to enjoy life, sometimes at the expense of their jobs," says Clement. "We're not a head-office city. We're a playground." A case in point: Duff Waddell left a job at a big downtown law firm 20 years ago so he would have more time to pursue sportive interests. "I realized I didn't want to work those long hours," he says. The payoff? Aside from the fact that he rarely takes a sick day off work, Waddell looks at least a decade younger than his 57 years. He clearly embodies a spin on the old adage that all work and no play would make Vancouver a very dull, and certainly less healthy, place to be.
Inside The Survey
This 15-page edition of the Maclean's Health Report presents the first-ever comprehensive comparison of the status of health of Canadians in specific communities across Canada. As well as documenting the relatively healthy lifestyles of Vancouverites and Torontonians, it points to some alarming hot spots for lethal conditions: Sudbury (heart disease); Quebec City (lung cancer) and Halifax (respiratory disease).
The data come from national indicators collected by Statistics Canada, primarily the most up-to-date mortality statistics at the regional level, from 1996. For Maclean's comparative purposes, StatsCan and the Canadian Institute for Health Information broke out the numbers for the health-care administrative regions based on 17 major communities, from Victoria to St. John's, Nfld., representing 40.4 per cent of the Canadian population. In every case but Toronto, those regions include neighbouring areas beyond the city boundary. StatsCan also standardized the numbers to take account of the age and gender differences among those communities' populations. Health-care administrators and other specialists in the field from across Canada agreed on the set of health-status indicators referred to in this report at a national conference that CIHI convened last May.
The mortality rates at the heart of this report may vary from year to year, especially for smaller regions. For that reason, the figures in this issue present a snapshot of the health-status successes and hot spots across Canada in 1996. Future editions of the Maclean's Health Report will track community data over subsequent years, offering an increasingly comprehensive portrait of the state of Canadians' health.
Living the Healthy Life
Of the 17 measured health regions, Vancouver/Richmond has the lowest mortality rates for:
- All cancers combined, for both men and women
- Breast cancer
- Circulatory disease
Toronto has the lowest mortality rates for:
- Lung cancer
- Respiratory disease
- Circulatory disease among men
On the Mean Streets
Vancouver's Gastown Medical Clinic is located at 30 Blood Alley, on the cusp of the despair that is the city's Downtown Eastside. There are no magazines or potted plants in the waiting room and the walls are bare, save for snapshots of individuals and groups of smiling people. They are patients of Dr. Stanley de Vlaming, the clinic's director, and all are recovering drug addicts. "The photos are meant to show the others in the waiting room an example of people who are doing well," says de Vlaming. Among the Gastown doctor's patients are 160 heroin and cocaine addicts who have tested positive for HIV, the virus that causes AIDS. "Most of my patients have been HIV-positive for three to five years," says de Vlaming. "Now, they are getting sicker as a population and are succumbing to opportunistic infections such as tuberculosis."
De Vlaming's patients are part of a grim picture emerging from Vancouver. Data compiled from 17 major cities and regions by Statistics Canada and the Canadian Institute for Health Information show Vancouver/Richmond with the country's highest rate of deaths from AIDS. Its 19 deaths per 100,000 population is significantly higher than in the country's other AIDS hot spots, Montreal (14) and Toronto (11). Since the introduction of powerful new drugs four years ago, AIDS deaths have been declining. The mortality statistics used in this Health Report date from 1996, the most recent year for comparable data at a community level and a time when the new drugs were just beginning to become available.
As elsewhere, gay men make up Vancouver's largest group of HIV/AIDS victims. But the city is also typical in finding increasing numbers of cases among women, including workers in the city's sex trade, and injection drug users. A special problem for Vancouver is the tendency of its cocaine addicts to inject, rather than inhale, their drug of choice. They may need up to 20 hits a day to stay high, which can increase needle sharing - and the risk of infection.
Still, following another nationwide trend, the rate of new HIV infections has declined in Vancouver during the past year. "It's the saturation effect," says Dr. Michael O'Shaughnessy, director of British Columbia's Centre for Excellence in HIV-AIDS. "The epidemic has slowed down probably because the highest-risk people have already been affected. People at risk two years ago now have the disease."
But paradoxically, the success of the new AIDS drugs may be encouraging some new infections by lulling young gay men into risking unprotected sex. As a result, says John Ah Chong, president for Aids Community Care Montreal, infections in that city may have begun to increase again. "It's not a definite trend yet," says Chong. "But some young men may not realize that unprotected sex can still cause you to get sick and die."
As the battle continues, de Vlaming has more help. Until last year, he was on his own in his Gastown clinic. Now, with new funding from the Vancouver-Richmond Health Board, he works with two addiction counsellors, and an infectious diseases expert makes regular visits. But even with increased resources, de Vlaming says the problem will take many years to overcome.
Maclean's October 25, 1999