WHY WHO'S DIET GUIDELINES ARE UNREALISTIC FOR MANY PEOPLE AROUND THE WORLD
An unhealthy diet and lack of physical activity are leading global risks to health, according to the World Health Organization .
But the problem, an SFU researcher says, is that advice is based on rich-world premises: In high-wage countries, fruit and vegetables don’t take as much out of household income, and an hour at the gym or paddling after work are generally affordable choices.
“Physical activity patterns are clearly different based on the development of a country, and based on individual or household income,” said Scott Lear , professor of health sciences and chair of the Pfizer/Heart and Stroke Foundation’s cardiovascular prevention research.
“We can’t always take our lessons from high-income countries, develop (international) guidelines, and then apply them to what is 80 per cent of the rest of the world.”
The study Lear was part of — Prospective Urban Rural Epidemiology, or PURE — began in India in 2002 and grew to include 28 countries on five continents, with 212,000 people participating, examining society’s influences on chronic noncommunicable disease around the world.
Lear’s focus was on cardiovascular disease, which is the leading cause of death worldwide, accounting for 80 per cent of deaths.
The WHO’s diet guidelines suggest at least five portions of fruit and vegetables a day (excluding starchy roots), but that’s just unrealistic for a lot of people, Lear said.
“It’s another thing I found interesting is the finding about fruits and vegetables,” he said, “and how farmers in low-income countries are priced out.
“Field workers say if they eat what they grow, they lose so much money by not selling it.
“For many of these farmers, getting the recommended minimum of five servings of fruits and vegetables a day would eat up 50 per cent of their household income.”
Another thing that is mainly taken for granted by the WHO, Lear said, is that any movement is good movement.
Tell that to someone working in a field or mine all day, or a stone mason.
“I’m looking out my window and they’re landscaping. One of the guys with a sledgehammer was breaking up the patio. He spent hours doing that,” Lear said.
“You wouldn’t go to the gym and do hours of endless bicep curls or bench presses.”
Then there’s the commute to work.
In lower-income countries, a lot of people take an hour and a half or more going each way, often by foot.
“There’s a stark contrast between a daily sidewalk stroll in Vancouver’s West End and walking to work in New Delhi, the world’s most polluted city, where many people cannot afford to drive and public transit is lacking,” Lear said. “We can’t assume that life is the same everywhere.
“The environments in which people live and the kind of work they do makes a huge difference to their health.”
PURE data is collected every three years and includes a core survey, physical measurements such as blood pressure, weight, height, lung capacity and waist-hip circumference, and a questionnaire.
On top of focusing on exercise and diet, Lear’s study identified several other causes behind the causes of cardiovascular disease worldwide, including nutrition, education, tobacco use, air pollution, climate change, social isolation and access to medication, treatment and health care.
About 87 per cent of PURE participants live in low- or middle-income countries, uniquely positioning the study to examine individual risk factors related to urbanization, Lear said.
Although these findings are based on global data, they also reflect the microcosms of different regions within a single city, or region, he said.
Lear joined the study 20 years ago.
“Early in my career, I thought, okay, everybody should be eating these foods, everybody should be physically active, and everything will be great.
“As I participated in the study, I started to realize that’s a very high-income-country privilege. It’s been eye-opening for me.”
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2025-05-27T13:13:59Z