Despite decades of public health campaigns promoting exercise and healthy eating, cardiovascular disease remains the leading cause of death worldwide. A groundbreaking analysis from Simon Fraser University reveals why our approach to heart health may be fundamentally flawed.
Dr. Scott Lear, a professor in SFU’s Faculty of Health Sciences, has identified critical gaps in global heart health guidelines that may explain their limited effectiveness across diverse populations. His research, published this week in the Journal of Clinical Cardiology, examined heart health recommendations from 27 countries and found troubling inconsistencies that fail to account for socioeconomic realities.
“We’ve been prescribing the same medicine for everyone without considering if patients can actually take it,” explains Dr. Lear. “Our analysis shows that standard advice like ‘exercise 150 minutes weekly’ or ‘eat five servings of fruits and vegetables daily’ simply isn’t feasible for millions of people worldwide.”
The study highlights how current guidelines largely ignore crucial barriers to implementation. In low-income communities across both developing and developed nations, recommended foods are often unaffordable or unavailable. Meanwhile, safe spaces for physical activity remain scarce in many urban environments, particularly for women and children.
Most concerning is the study’s finding that 86% of examined guidelines were developed by panels consisting almost exclusively of researchers and clinicians from high-income settings, with minimal input from community representatives or experts in social determinants of health.
“We’re seeing a disconnect between what health authorities recommend and what’s actually achievable,” says Dr. Maria Santos, a cardiologist at Toronto General Hospital not involved in the research. “When we tell patients to make lifestyle changes without addressing their economic constraints or cultural context, we’re setting them up for failure.”
The research team documented stark examples of this disconnect. In regions where the average daily income falls below $5 USD, recommendations to purchase specialized exercise equipment or consume expensive imported foods become virtually meaningless. Similarly, advice to “take walks in your neighborhood” neglects the reality of unsafe streets, extreme weather conditions, or cultural barriers to women exercising in public spaces.
Dr. Lear’s work suggests a radical rethinking of how heart health guidelines are developed and implemented. The study recommends creating culturally-specific guidelines that acknowledge local constraints while leveraging community assets. This might mean promoting traditional diets that are both heart-healthy and locally available, or identifying culturally appropriate physical activities that don’t require special equipment or facilities.
The CO24 Health team spoke with several Toronto residents about the findings. James Wilson, a 58-year-old living in a food desert neighborhood, shared: “My doctor tells me to eat more fresh produce, but the nearest grocery store is an hour away by bus. Meanwhile, there are three fast food places within walking distance.”
The implications extend beyond individual health outcomes. According to the Canadian Heart and Stroke Foundation, cardiovascular disease costs the Canadian healthcare system approximately $21 billion annually in direct and indirect costs.
Public health officials are beginning to take note. Health Canada has announced plans to review its cardiovascular disease prevention strategies in light of these findings, with particular attention to accessibility across diverse socioeconomic groups.
“We need to move beyond a one-size-fits-all approach,” concludes Dr. Lear. “Effective heart health guidelines must recognize that people’s ability to make healthy choices is shaped by their environment, income, and cultural context.”
As cardiovascular disease rates continue to rise globally despite decades of intervention, we must ask ourselves: Are we failing to improve heart health because our guidelines ignore the very real constraints that shape people’s daily choices?
