A leading researcher from Simon Fraser University is warning that global heart health guidelines may not work for everyone, especially for people living in low- and middle-income countries.
Dr. Scott Lear, a professor of health sciences and expert in heart disease prevention, says that many of the current recommendations are based on studies done in wealthy countries and don’t always take into account the different environments and challenges people face elsewhere in the world.
Cardiovascular disease (CVD) is the number one cause of death around the world, with 80% of deaths happening in poorer countries.
Yet most health advice—like exercising for 75 minutes a week or eating five servings of fruits and vegetables daily—is designed with people in high-income countries in mind.
Dr. Lear highlights that a walk in Vancouver, Canada, is very different from walking to work in New Delhi, India—one of the most polluted cities in the world. In New Delhi, many people can’t afford cars or access public transportation, making everyday tasks much harder and more dangerous.
His recent review looked at the “causes behind the causes” of CVD using data from the Prospective Urban Rural Epidemiology (PURE) study.
This long-running study involves over 212,000 people in 28 countries and collects information about lifestyle, health, and living conditions every three years. Most of the participants live in low- or middle-income countries.
The review found that factors such as poor air quality, lack of access to healthy food, limited education, smoking, climate change, and social isolation all increase the risk of heart disease. Access to health care and medication also varies greatly between countries.
Dr. Lear points out that even physical activity, often seen as key to heart health, is affected by privilege. In wealthy countries, people are more likely to engage in leisure activities like jogging or going to the gym—even though they might sit for long hours at work.
In contrast, people in poorer countries do more physical work or walk as part of daily life but don’t necessarily engage in structured exercise. Surprisingly, the overall reported activity levels are still lower in these regions.
Food access also varies widely. While fruits and vegetables are more affordable and available in cities across all income levels, many people in rural or low-income areas still can’t afford them.
Some farmers even sell all their produce because they need the money and can’t afford to eat what they grow. In fact, in some cases, eating the recommended five servings of fruits and vegetables a day would cost a family half their income.
This research shows that one-size-fits-all health advice may not be fair or effective for everyone. Dr. Lear hopes it will encourage global health experts to consider local environments, economic conditions, and daily challenges when making recommendations for heart disease prevention.
If you care about heart health, please read studies about top 10 foods for a healthy heart, and how to eat right for heart rhythm disorders.
For more health information, please see recent studies about how to eat your way to cleaner arteries, and salt and heart health: does less really mean more?
The study is published in European Heart Journal.
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