Diabetes: Where You Live Matters! What You Need to Know About Diabetes in Toronto Neighbourhoods Peter Gozdyra, Marisa Creatore, CRICH 1
Tonight s talk Provide highlights of a large body of work Stimulate discussion: Your neighbourhoods Implications for what you do 2
Why diabetes? Over 177 million people with diabetes worldwide (WHO, 2000) Over 2 million Canadians living with diabetes In Ontario the proportion of people with diabetes rose 69% (from 5.2% to 8.8%) between 1994 and 2005 Major cause of heart attack, kidney failure, blindness, amputation Huge impact on quality of life and health care costs 3
What puts you at risk? Age Family history (genes) Ethnicity/race (Aboriginal, Hispanic, South Asian, Asian, African) Income & Education Obesity* (*the most important risk factor for type 2) 4
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Some Trends Diabetes higher in neighbourhoods with: Income Immigration levels 6
Defying the odds In Toronto, some low-income, high immigration neighbourhoods defy this trend e.g. Moss Park, South Parkdale, Regent Park, North St.Jamestown 7
Defying the Odds WHAT S GOING ON IN THESE NEIGHBOURHOODS? 8
21 st Century Trends Unhealthy diets Sedentary & inactive lifestylves 9
Taking a look at Toronto Neighbourhoods 10
Income by neighbourhood 30-50,000 50-75,000 75-100,000 100-150,000 150-375,000 Data Source: 2001 Census 11 Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto
Visible minorities 7-15% 16-30% 31-45% 46-65% 66-90% Data Source: 2001 Census 12 Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto
Flemingdon Park Immigration & Ethnic Origin Data Source: 2001 Census from Toronto Neighbourhood Profiles, http://www.toronto.ca/demographics/neighbourhoods.htm 13
Neighbourhood Resources 14
Grocery stores, fruit & vegetable stands # outlets per 10,000 population 0.0-3.0 3.0-6.0 6.1-10.0 10.1-13.0 13.1-26.3 Data source: City of Toronto 2004 Employment Survey, Ontario Food Terminal data (Canadian Urban Institute) 15
Locations of fruit & vegetable stands in Flemingdon Park 16 Data source: City of Toronto 2004 Employment Survey, Ontario Food Terminal data (Canadian Urban Institute)
Modelled walking time to nearest grocery store or fruit and vegetable stand in minutes, in Toronto, 2004 17
Neighbourhood Structure 18
How do you define a healthy neighbourhood? 19
How old is your neighbourhood? 20
Average number of cars per household # per household 0.5-0.7 0.8-0.9 1.0-1.1 1.2-1.3 1.4-1.6 Data Source: 2001 Transportation Tomorrow Survey (University of Toronto, 2001) 21 Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto
Average wait times for TTC vehicles 22
Daily transit (TTC) trips per person # trips / person 0.10-0.30 0.31-0.40 0.41-0.50 0.51-0.60 0.61-0.84 Data Source: 2001 Transportation Tomorrow Survey (University of Toronto, 2001) 23 Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto
Bike routes and average number of biking trips per 1000 persons 24
Putting it all together Do more neighbourhood resources that encourage physical activity = more physical activity? Let s Find Out 25
How activity-friendly is your neighbourhood? Neighbourhood Features: more people more stores stores closer to your home fewer cars less crime 26
Activity-Friendly Index Components of Healthy Resources Index: 1. Car ownership (reversed) 2. Population /km2 of residential area 3. Retail services per 10K population 4. Crime per 100K of MaxPop (reversed) 5. Ave distance from residential points to the nearest 5 services (reversed) 27
Daily walking/biking trips per person # trips / person 0.06-0.10 0.11-0.20 0.21-0.30 0.31-0.50 0.51-0.76 Data Source: 2001 Transportation Tomorrow Survey (University of Toronto, 2001) 28 Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto
Putting it all together II Is Neighbourhood Activity Friendliness Related to Diabetes? 29
Spatial relationship: diabetes and AFI High DM rates High DM rates Low DM rates Low DM rates Lower AFI score Higher AFI score Higher AFI score Lower AFI score Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto 30
Diabetes rates 1 2, 3 4 1 North St. Jamestown 2 Moss Park 3 Regent Park 4 South Parkdale 2.8-4.1% 4.2-5.1% 5.2-5.8% 5.9-6.5% 6.6-7.6% Data Source: Ontario Diabetes Database 31 Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto
Key Finding # 1 Diabetes rates are highest in areas that have: lower income levels a higher proportion of visible minorities high immigration rates 32
Key Finding # 2 High diabetes areas tend to be outside of downtown and have generally worse: access to resources activity friendliness 33
Key Finding # 3 Neighbourhoods are affected differently: Downtown high risk areas have lower diabetes rates than expected Wealthy areas have low diabetes rates, no matter their access to resources or activity friendliness 34
Implications Make communities more activity friendly Reduce our dependence on cars Promotion of healthy lifestyles must go hand-in-hand with neighbourhood resources and opportunities Improve public transit in under-served areas Prioritize high risk neighbourhoods 35
Team Rick Glazier and Gillian Booth, Editors Peter Gozdyra, Geographer Marisa Creatore, Epidemiologist Anne-Marie Tynan, Coordinator Students: Kelly Ross, Jonathan Weyman, Amanda Maze 36
Support St. Michael s Hospital BMO Financial Institute for Clinical Evaluative Sciences 37
Resources Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto Also available at: www.torontohealthprofiles.ca And www.ices.on.ca 38
Key Findings: Neighbourhood Resources Many high diabetes areas have long walking times (> 20 mins each way) to: Stores that sell healthy foods Recreation spaces Parks & schoolyards Don t know what to do with this it was suggested that (current) slides 39 and 40 replace slides 32, 33, and 34 Areas of the city with the highest diabetes rates have lower access to family physicians and diabetes programs 39
Key Findings: Promoting healthy lifestyle Areas of the city with the highest diabetes rates have among the lowest rates of walking or biking and public Don t transit know use what to do with this it was suggested that (current) slides 39 and 40 replace slides 32, 33, and 34 Areas of the city with the highest diabetes rates have lower AFI scores (ie. less activity friendly: diabetes) 40
Socioeconomic status by neighbourhood Data Source: 2001 Census from Toronto Neighbourhood Profiles, http://www.toronto.ca/demographics/neighbourhoods.htm 41
Modelled transit time to the nearest diabetes education program in minutes, in Toronto, 2004 42
Percent of people physically inactive [2001-2003] 43
Average walking time to the nearest TTC route 44
Average walking time to the nearest TTC route and average wait times for TTC vehicles 45
Key Finding: Multiple Risks Many neighbourhoods with high diabetes rates and low AFI also have high proportions of low income and visible minority populations 46
Association between walking/biking patterns and presence of high/low diabetes rates High DM Lower % walking High DM Higher % walking Low DM Lower % walking Low DM Higher % walking Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto 47
Key Finding # 3 Areas of the city with the highest diabetes rates have among the lowest rates of walking or biking and transit use They also score low on our measure of activity friendliness 48