Health literacy: Informed decisions lead to good health

staffordBy Dr. Stafford Dobbin, Medical Director, Healthy Heart Schools’ Program

Agencies raising money to fight cancer are more successful than those fighting heart disease. However, most Canadians will end up with heart disease rather than cancer.

Over the past 50 years, cancer prevention has expanded. There are several annual screening programs, even for younger age groups, and especially for those with positive family histories. Screening methods include mammograms, colonoscopies, blood tests, CT, MRI scans, dermatology consults, and more.

Every February, during Heart Month, the prevention of heart disease clings to a weak public health outcry to smoke less, exercise more, and eat better.  The family history is rarely mentioned.

A surprisingly 50% of all deaths in men over 55 years old are from heart disease, compared to 25% from cancer. Deaths in women over 65 years old are 56% from heart disease, and 20% from cancer.  The cost of disability in heart attack survivors is massive compared to the cost of surviving cancer.

The factors that cause heart attacks begin in adolescence and are very predictable even in young children. Hardening of the arteries, also called atherosclerosis, in at-risk individuals, will be established by 25 years of age. Unfortunately, very little is done to educate adolescents in becoming heart health literate.

Arteriosclerotic plaque, blocked arteries and subsequent heart attack are associated with a family history of cardiovascular disease. This history could include premature heart attack or stroke, abnormal levels of blood fats or cholesterol, a raised level of blood sugar or blood pressure, abdominal obesity, smoking, a lack of physical activity, daily inactivity, and a diet promoting blood fats. All of these can be identified at a time when every family in the whole population is available for intervention: when the children are at school.

The opponents of this intervention argue that awareness of risk does not make people change their behavior.  Along with numerous studies and prior knowledge of a family cancer – only some people will make choices based on that awareness.

Most families are unaware of heart disease risk factors. They are also unaware that if their grandfather experienced a heart attack at 50 years old, they are at risk too.

To stop making people aware of their future risk because some will choose not to change, even if they’re considered high risk, is foolish. It would also ignore the fact that families and individual adolescents have the right to know about those risks at a time when they can make an informed decision.

Imagine if all Niagara adolescents and their families became heart health literate? They would understand the genetic significance of having a family member who had a heart attack or stroke at an early age.

An adolescent’s health literacy could be further improved by knowing and understanding blood cholesterol, blood triglyceride (fat) levels, blood sugar level, blood pressure and waist to height ratio measurements.

Comprehending the risk of heart disease may lead to being a non-smoker, daily physical activity, proper weight management, and a heart healthy diet.

A majority of people don’t realize that they’re overweight.  They use words such as “stocky” or “chubby” to describe their body type.  No matter what the label, the reality is that if you are overweight you may develop hypertension, diabetes and atherosclerosis.  These conditions will put you at high risk of cardiovascular disease.

Opponents of intervention resist telling people that they are overweight.  While at-risk levels of blood cholesterol, blood sugar and blood pressure do not constitute a disease: obesity certainly does, especially abdominal obesity. So, the argument against intervention now involves not notifying individuals that they have a disease. Why?  Do we not want to upset them? Does it upset a paratrooper to give him a parachute?

We tell children they have cystic fibrosis, asthma, coeliac disease, heart murmurs etc. Children quickly learn to live with those.  Although, we are not to tell them and their families that they are have a recognized disease called, obesity. These children are at risk for the development of conditions once thought to be diseases of adulthood: cardiovascular disease, diabetes, high cholesterol and hypertension.

Health literacy affects people’s ability to make informed decisions that lead to good health. Providing all children and families with clear information about health promotion and disease prevention should be a priority.


Heart Niagara’s Healthy Heart Schools’ Program was established in 1987.  The program works with local schools to deliver lifesaving and disease prevention education to students in grades 5, 7 and 9.

Over the years, more than 60,000 students have been visited through a partnership between Heart Niagara, Niagara Regional Public Health and each of the school boards.

The results are used to help educate students about heart disease risk factors and the importance of living a healthy heart lifestyle.

For more information contact Heart Niagara at 905-358-5552, email

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