Governments Should Take an Active Lead in Creating Healthy Food Environments to Prevent Cardiovascular Disease, Say Cardiovascular Care Experts

In a policy statement published in the CanadianJournal of Cardiology, fifteen health organizations support a call for actionto increase access to affordable healthy foods to improve cardiovascular health

Philadelphia, PA, October 28, 2014

Canadian health organizations are calling upon governmentsto take a leadership role in creating healthy food environments. They say thatimplementing strategies that facilitate access to affordable healthy foods andbeverages in places where Canadians work, live, and play could play a key rolein preventing diet-related disease and health risk such as obesity andhypertension, and ultimately improve cardiovascular health, This call foraction is published in the CanadianJournal of Cardiology.

In 2010, unhealthy eating was identified as the leading riskfor death and disability both in Canada and globally. In Canada, as in mostindustrialized countries, preventable cardiovascular disease, diabetes, cancer,and chronic respiratory disease account for roughly two-thirds of all deathseach year. Poor diet, broadly defined by the World Health Organization (WHO) asone being high in sodium, saturated and trans fats, free sugar, and low infresh fruits and vegetables, is among the leading risk factors.

Led by the Canadian Institutes of Health Research/Heart& Stroke Foundation of Canada (CIHR/HSF) Chair in Hypertension Preventionand Control and supported by fifteen leading national and provincial healthorganizations, this position statement calls upon governments to take action todevelop and implement healthy food procurement policies across the spectrum ofour society. It also outlines key roles and recommendations for the commercialand non-commercial sectors including health and scientific organizations aswell as the Canadian public.

The statement is based on a systematic review of theliterature that found healthy food procurement interventions do have animportant impact on food purchases within closed systems such as schools,workplaces, and isolated communities. The review further acknowledged thatsuccessful food procurement policies are nearly always accompanied bysupporting education programs and sometimes by pricing policies, such astaxation or subsidies. 

This statement is part of an international movement toreduce dietary risk, with the recognition that toxic foods (with excessiveamounts of sugar, fat, refined grain products, and/or salt) are responsible forsubstantial population sickness and premature death. The supportingorganizations call on all individuals, but specifically those withorganizational responsibility for others, to immediately begin to work onimplementing healthy food procurement policies as part of a comprehensiveapproach to reduce dietary risk and prevent diet-related disease.

"Education, knowledge, and awareness are not enough.Extensive education over a period of years, even in clinical trial settings,has only a small sustained impact on sodium consumption and obesity reduction,"says Norm Campbell, MD, FRCPC, Professor of Medicine, Physiology andPharmacology and Community Health Sciences, at the Libin CardiovascularInstitute of Alberta, University of Calgary, Alberta, Canada, and chair of theCanadian Hypertension Advisory Committee. "The solution advocated by the UnitedNations and WHO focuses on a series of integrated governmental policies toimprove the food environment coupled with education. Studies in the US showthat implementing healthy food procurement policies in the commercial sector asa part of a worksite wellness program has the potential to save businessesmoney through improved productivity and reduced absenteeism. Canada has theopportunity to do the same through widespread adoption of such policies.Canadians can't make healthy choices if they don't have an environment thatsupports them making such choices. This is one step in that direction."

Among the recommendations are:

  • In conjunction with healthy food procurement, implement an education program about healthy eating and describe the rationale for the food procurement policy to ensure support and to increase awareness, desire, and demand for healthy dietary choices.
  • Encourage consumption of fresh foods (fruits, vegetables, etc.) or if not available, frozen or canned (without addition of sodium, sugar, or fats).
  • Take steps to ensure healthier foods and beverages are affordable.
  • Ensure that foods are well suited to the tastes/preferences/dietary needs of the population being served (e.g., age, ethno-cultural groups).
  • Include criteria for the amount of sodium, free sugars, trans fatty acids, saturated fats, and calories as well as other nutrients likely to impact health (e.g., dietary fiber) in the food being served.
  • Use national standards such as the Canadian Dietary Reference Intake Values, developed by the Institute of Medicine, and Canada's Guide to Healthy Eating in developing criteria for foods.
  • Make gradual changes in the nutrient criteria where personal tastes require time to adapt to change (e.g., sodium).
  • Update the policy periodically to reflect current nutrient needs.
  • Evaluate the implementation program and, where appropriate, introduce effective incentives for compliance.

This call to action is supported by the Alberta PolicyCoalition for Chronic Disease Prevention, Canadian Association of CardiacRehabilitation and Prevention, Canadian Association on Gerontology, CanadianCouncil of Cardiovascular Nurses, Canadian Diabetes Association, CanadianGeriatrics Society, Canadian Nurses Association, Canadian Society for ExercisePhysiology, Canadian Society of Internal Medicine, Canadian Society ofNephrology, Canadian Stroke Network, Champlain Cardiovascular DiseasePrevention Network, College of Family Physicians of Canada, Heart and StrokeFoundation, and Hypertension Canada.

In a timely viewpoint article, "Death by Diet: The Role ofFood Pricing Interventions as a Public Policy Response and Health AdvocacyOpportunity," published in the same issue, experts discuss the role of healthprofessionals as health advocatesand the corresponding opportunity to support other population level approaches,namely food taxes and subsidies, to improve diet for the prevention ofdiet-related chronic disease.

"Similar toefforts being proposed in other countries, Canada needs a comprehensive agendafor action to curb the rising tide of diet-related disease. While this paperhighlights the need for more research in the area of diet and policy-levelstrategies, it also identifies the opportunity for the cardiovascular communityto be involved in policy initiatives and partnerships to begin to translatewhat we know can work into action and implementation," say lead authorTara Duhaney, MHSc, Policy Director of the Canadian Hypertension AdvisoryCommittee, Alberta, Canada, and Norm Campbell, MD, FRCPC. "We hope this will further discussion,support, and action by all vested stakeholders including health professionals,researchers, communities, and, importantly, by all levels of government."


Notes for editors
"Healthy Food Procurement Policy: An Important Interventionto Aid the Reduction in Chronic Non-Communicable Diseases," by Norm R.C.Campbell, MD; Tara Duhaney, MSc; Manuel Arango, MA, MHA; Lisa A. Ashley, RN,MEd, CCHN(C); Simon L. Bacon, PhD, FTOS ; Mark Gelfer, MD; Janusz Kaczorowski,PhD; Eric Mang, MPH; Dorothy Morris , RN, MA; Seema Nagpal, BSc(Pharm), MSc,PhD; and Kevin J. Willis, PhD, DOI: Journal of Cardiology,Volume 30, Issue 11 (November 2014), published by Elsevier.

"Death by Diet: The Role of FoodPricing Interventions as a Public Policy Response and Health AdvocacyOpportunity," by Tara Mary Duhaney, MHSc; Norm R. Campbell, MD; Mark L.Niebylsk, PhD; Janusz Kaczorowski, PhD; Ross T Tsuyuki, BSc(Pharm), PharmD,MSc, FCSHP; Kevin Willis, PhD; Eric Mang, MPA; Manuel Arango, MA, MHA; DorothyMorris , RN MEd, CCHN(C); and Lisa A. Ashley, RN MEd, CCHN(C), DOI: Canadian Journal of Cardiology, online in advance of Volume 31,Issue 2 (February 2015), published by Elsevier.

Full text of the articles is available to credentialedjournalists upon request. Contact EileenLeahy at +1 732 238 3628or to obtain copies.Journalists who wish to interview Dr. Campbell may contact him via MartaCyperling, Media Relations Manager, Cumming School of Medicine, University ofCalgary, at +1 403 210 3835 or Dr.Campbell may be contacted directly at +1 403 210 3955 or or through JudyWong at +1 403 210 7961. Journalistswho wish to contact Ms. Duhaney may contact her at +1 403 220 5727 or

About the Canadian Journal Of Cardiology
The Canadian Journal of Cardiology ( is the official journal ofthe Canadian Cardiovascular Society ( is a vehicle for the international dissemination of new knowledge incardiology and cardiovascular science, particularly serving as a major venuefor the results of Canadian cardiovascular research and Society guidelines. Thejournal publishes original reports of clinical and basic research relevant tocardiovascular medicine as well as editorials, review articles, case reports,and papers on health outcomes, policy research, ethics, medical history, andpolitical issues affecting practice.

About theeditor-in-chief
Editor-in-Chief Stanley Nattel, MD, is Paul-David Chair inCardiovascular Electrophysiology and Professor of Medicine at the University ofMontreal and Director of the Electrophysiology Research Program at the MontrealHeart Institute Research Center.

About the CanadianCardiovascular Society
The Canadian Cardiovascular Society is the professionalassociation for Canadian cardiovascular physicians and scientists working topromote cardiovascular health and care through knowledge translation,professional development, and leadership in health policy. The CCS providesprograms and services to its 1900+ members and others in the cardiovascularcommunity, including guidelines for cardiovascular care, the annual CanadianCardiovascular Congress, and, with the Canadian Cardiovascular Academy,programs for trainees. More information about the CCS and its activities can befound at

About Elsevier
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Media contact
Eileen Leahy
+1 732 238 3628