1. Diabetes in Toronto: Where You Live Makes a Difference Rick Glazier, CRICH October 2, 2007 2

2. Why diabetes? Obesity –1 in 2 Canadian adults now overweight –overweight and obesity in children nearly quadrupled since 1980s –related to sedentary living, eating habits Diabetes –obesity is the most important risk factor (type 2) –major cause of heart attack, kidney failure, blindness, amputation –huge impact on quality of life and health care costs

3. Today’s talk Provide highlights of a large body of work Stimulate discussion: –Your neighbourhoods –Implications for what you do

4. Methods: data sources Administrative data –Ontario Diabetes Database 2001 Canadian census –income, immigration, visible minority –population density Other data sources –CCHS –City of Toronto –Ontario food terminal –Land use files –Transportation Tomorrow Survey –2001 Police reports

5. Who Lives Where?

6. High & low income households Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto 30 - 50,000 50 - 75,000 75 - 100,000 100- 150,000 150- 375,000 Data Source: 2001 Census

7. Visible minorities Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto 7-15% 16-30% 31-45% 46-65% 66-90% Data Source: 2001 Census

8. People with diabetes* Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto 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 (*Age and Sex Adjusted)

9. Neighbourhood Resources

10. Groceries, fruits & vegetables 0.0 - 3.0 3.0 - 6.0 6.1-10.0 10.1-13.0 13.1-26.3 # outlets per 10,000 population Data source: City of Toronto 2004 Employment Survey, Ontario Food Terminal data (Canadian Urban Institute)

11. Walk to groceries, fruit & vegetables (red 20-40 minutes)

12. Access to healthy resources (foods, parks, recreation, doctors)

13. Spatial relationship between geographic access to healthy resources and diabetes rates

14. St. Michael’s Hospital neighbourhoods are unusual

15. Neighbourhoods

16. Older and newer housing

17. Daily walking/biking trips per person 0.06- 0.10 0.11- 0.20 0.21- 0.30 0.31- 0.50 0.51- 0.76 # trips / person Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto Data Source: 2001 Transportation Tomorrow Survey (University of Toronto, 2001)

18. Daily transit (TTC) trips per person 0.10- 0.30 0.31- 0.40 0.41- 0.50 0.51- 0.60 0.61- 0.84 # trips / person Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto Data Source: 2001 Transportation Tomorrow Survey (University of Toronto, 2001)

19. Average number of cars per household 0.5- 0.7 0.8- 0.9 1.0- 1.1 1.2- 1.3 1.4- 1.6 # per household Data Source: 2001 Transportation Tomorrow Survey (University of Toronto, 2001) Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto

20. “Activity Friendly” Neighbourhoods Environmental Features: – population density – service density – service proximity – car ownership – drug and violent crime rates

21. Activity-Friendly Neighbourhoods 2.2 - 3.4 3.5 - 4.1 4.2 - 4.9 5.0 - 5.7 5.8 - 7.2 c AFI Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto

22. Diabetes & Activity Friendly Neighbourhoods High DM rates Low DM rates Lower AFI score Higher AFI score Lower AFI score Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto

23. Key Finding # 1 Diabetes rates are highest in areas that have: – lower income levels –higher unemployment rates –a higher percentage of population without high school education –a higher proportion of visible minorities –high immigration rates

24. Key Finding # 2 High diabetes areas tend to be outside of downtown and have generally worse: –access to resources –activity friendliness

25. 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

26. Team Rick Glazier and Gillian Booth, Editors Peter Gozdrya, Geographer Marisa Creatore, Epidemiologist Anne-Marie Tynan, Coordinator Kelly Ross, Jonathan Weyman, Students

27. Support St. Michael’s Hospital BMO Financial Group Institute for Clinical Evaluative Sciences

28. Resources www.TorontoHealthProfiles.ca November 1, 2007 Neighbourhood Environments and Resources for Healthy Living: A Focus on Diabetes in Toronto

29. Implications Make communities more activity friendly Reduce our dependence on cars Provide more opportunities physical activity More opportunities for healthy eating Enhance access to health services in high need areas Prioritize high risk neighbourhoods