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n September 2004, Canadian researchers from the Population Health Research Institute at McMaster University and the Hamilton Health Sciences Centre published the largest international study ever undertaken on cardiovascular disease.

The INTERHEART study involved over 30,000 people from many ethnic and cultural groups in 52 countries from across the globe. The researchers, led by Dr. Salim Yusuf, embarked on this study to develop a global strategy to prevent cardiovascular disease because it is estimated to be the leading cause of death worldwide.

The INTERHEART study found that nine risk factors account for 90% of the world's cardiovascular disease. This means that regardless of where you live in the world, or to which ethnic or cultural group you belong, the exact same factors predict your likelihood of developing cardiovascular disease. They are:

1. Smoking
2. Bad cholesterol (abnormal lipids)
3. High blood pressure (hypertension)
4. Diabetes
5. Size of your waistline (abdominal obesity)
6. Psychosocial factors (e.g. depression and stress)
7. Lack of fruits and vegetables
8. Lack of physical exercise
9. Level of alcohol consumption

	The most important message we can take from this study is that cardiovascular disease is preventable.

The INTERHEART study showed that, to a much greater degree than was previously believed, good health is determined by what we do. We now know that 90%, not 50% as was previously believed, of heart disease is accounted for by these modifiable risk factors. Being physically active, maintaining a healthy weight and not smoking are examples of actions we can take to protect our hearts. Contrary to what was previously believed, heredity, the genes we are born with, do not play as large a role as once thought in our likelihood of developing cardiovascular disease. So if your parents or siblings have or had heart disease, you are not necessarily bound to suffer the same fate.

The message that cardiovascular disease is preventable is an important one for Canadians. It means that we can all take steps -- as individuals, families, and communities -- to reduce the personal, social and economic burdens of cardiovascular disease.

			What is Health Promotion?
			Health promotion is working together for healthy lifestyles and healthy living conditions. Health promotion is about change, taking action and people working together to help one another and their communities. Health promotion works at many levels - individual, family, community and society to promote good health and prevent chronic disease. Health promotion action areas include: Advocating for healthy public policies Encouraging community action Creating supportive environments at school, work and within the community Providing information and education Involving non-health sectors Source: Ontario Prevention Clearinghouse Stroke Prevention Initiative

When we focus on health from many perspectives, this approach is called Health Promotion. The INTERHEART study provides a rare opportunity to highlight how health promotion can help us to broaden our thinking about what makes us healthy or not.

Promoting healthy lifestyles for Canadians

Health promotion encourages us to make healthy choices for our bodies to 'modify' our risk factors for heart disease. This is backed up by the study. The kinds of food we eat, the amount of exercise our bodies get and whether or not we smoke play a larger role than genetics in determining whether we develop cardiovascular disease or not.

Dr. Enrique Garcia, Research Associate from the Alberta Centre for Active Living heralds the study's findings as good news for Canadians. "The results of this large-scale, well-designed study are encouraging in that they suggest that these risk factors are potentially modifiable by changes in lifestyle regardless of gender, geographic region, and ethnicity."

Widening the lens - promoting community and societal health

We may know that to have a healthy heart, we need to maintain a healthy weight, exercise regularly and eat lots of fruit and vegetables. For some people, making healthy choices may be easier said than done.

	A health promotion approach takes our individual health and then applies a broader lens to the question of how to prevent cardiovascular disease.

A health promotion approach looks at those nine risk factors in the INTERHEART study that predict our risk of cardiovascular disease, and then adds one more layer: the broader social and economic determinants of health that have a major impact in shaping our health and longevity. These are the social, economic and environmental factors that affect people's lives in addition to our individual behaviours like physical exercise and smoking.

			Healthy actions today for healthy hearts tomorrow
			In our homes Be sure to choose a healthy diet and get regular exercise as well as avoiding smoking. Check out the Best Start Resource Centre for more information In our communities Join with others in the community to ensure that programs and services - like parenting support groups, free or low cost youth recreation activities, school nutrition programs, breastfeeding support programs are available to promote healthy child development. Consult the list of partners of Child and Family Canada for links to organizations with local partners in your community In our society There are many changes that governments can make to public policies that will do more to promote healthy child development and prevent cardiovascular disease in the long run. Healthy public policies that promote healthy child development address things like housing, day care and early childhood education, tax benefits for parents, and income assistance for the unemployed. Visit the Take Action section on the Campaign 2000 website for more information

1. Income and Social Status
2. Social Support Networks
3. Education and Literacy
4. Employment/Working Conditions
5. Social Environments
6. Physical Environments
7. Personal Health Practices and Coping Skills
8. Healthy Child Development
9. Biology and Genetic Endowment
10. Health Services
11. Gender
12. Culture

In fact, the INTERHEART study adds to the findings of previous research on heart disease that show how the effects of all 12 determinants of health interact and accumulate over the course of people's lives.

By examining all 12 determinants of health, we can begin to understand how factors such as the food we eat, the jobs and income we have, the air we breathe, and our access to education all impact our health.

Let's look at how this health promotion approach works with one issue as an example: obesity and poor diets. It is well known that healthy diets are key to good health and crucial in preventing the development of cardiovascular disease and other chronic diseases. In fact, as we have seen, diet and obesity are implicated in nearly all of the nine risk factors identified by the INTERHEART study.

Getting at the root of the problem of obesity and poor diets requires examining the determinants of health and their impact on these risk factors. For example, when people live in poverty, they have fewer opportunities to choose healthy food, and less time and money for recreational physical activity.

Dr. Dennis Raphael of the School of Health Policy and Management at York University, in Toronto has written extensively about the relationship between poverty and cardiovascular disease. "People's lives are embedded in material conditions," he says. "For example, when I reviewed the literature on heart disease, I was struck by the fact that income swamped all the other factors in its association with the development of cardiovascular disease."

The authors of the INTERHEART study suggest that developing prevention strategies that address the determinants of health is a priority for action. Health promotion challenges us to prevent heart disease before it starts - and that means tackling the issue of childhood obesity. As with adults, the barriers to healthy living may be rooted in the determinants of health.

			Child Poverty and Childhood Obesity - Canadian Statistics
			One in six children lives in poverty (2003 Report Card on Child Poverty in Canada produced by Campaign 2000.) Nearly 40% of food bank recipients are children (Canadian Association of Food Banks' HungerCount 2004 survey) One third of children are overweight (Community Prevention of Childhood Obesity)

A healthy childhood is a key determinant of health, and children's health can be threatened by both poverty and obesity. According to the National Longitudinal Survey of Children and Youth, as family income increases, the proportion of overweight children decreases.

Preventing heart disease starts with taking action on behalf of our children to ensure healthy hearts in the future.

	To prevent cardiovascular disease in adults, we need to address child poverty and child obesity at the same time.

Perhaps the most exciting part of a study like INTERHEART is that it gives us both the information and the inspiration we need to take action.

Preventing cardiovascular disease is within our reach. The findings of the INTERHEART study indicate that positive actions we take as individuals, families and communities can drastically reduce our chances of developing cardiovascular disease. Health promotion challenges us to make a difference today for a healthier tomorrow.