Canada’s heart health up in the air, says the 2008 Heart and Stroke Foundation Report Card on Canadians’ Health 

Air pollution is now a year-long threat to the heart health of Canadians, says the 2008 Heart and Stroke Foundation Report Card on Canadians’ Health. Yet a national poll by the Foundation has revealed that only 13% of Canadians have made the connection between air pollution and cardiovascular disease.  

Every year, there are approximately 6,000 additional deaths in Canada because of short term exposure to air pollution, and research suggests that 69% of these deaths come in the form of cardio and cerebrovascular disease.

 “Since the early 1990s, a growing body of evidence from Canada, the U.S. and Europe has documented increased rates of heart attack, and more hospitalizations for serious heart diseases such as heart failure, and stroke, after both short and long-term exposure to polluted air,” says Dr. Beth Abramson, Heart and Stroke Foundation spokesperson and cardiologist.                                                                                 

According to the Heart and Stroke Foundation, length of exposure is a critical determinant of the impact of air pollution on cardiovascular disease risk. Studies in different cities and countries have produced different results, but research shows that every 10-microgram/m3 increase in long-term exposure to fine particulate matter (PM2.5) can increase the risk of dying from heart disease and stroke -- in some individuals by as much as 76%. Even short-term exposure can be dangerous. One study has reported that a day-to-day increase in a PM 2.5 level as low as 20-microgram/m3 can elevate the risk of heart attack within 24-hours by 69%.  

Short-term exposure is only the tip of the iceberg because no part of the country is free from the long-term effects of bad air. Environment Canada estimates that at least 30% of Canadians are being exposed to higher than acceptable levels of fine particulates. Yet, between 2001 and 2005, there has been no significant change in fine particulate pollution in Canada 

Air Quality and Cardiovascular Risk


Highest 3-yr average 98th %ile PM2.5* (in mg/m3) observed in the province

Grade: Impact on heart health





British Columbia





Interior: F
Lower Mainland: D








Data not available



















New Brunswick






Nova Scotia

Data not available


Data not available

Newfoundland & Labrador






Source: Environment Canada

*the term fine particles, or particulate matter 2.5 (PM2.5), refers to tiny particles or droplets in the air that are two and one half microns or less in diameter. These particles come from many different sources and large amounts also form in the atmosphere from gaseous air pollutants interacting with each other in the presence of sunlight and water. The Canada-wide Standard for PM2.5 is based upon the 98th percentile (%ile) among a year of 24-hour measurements. An area has not achieved the CWS if the average of three consecutive year’s of 98th %iles is above 30 mg/m3.

Legend: F= >30, D= 25-30, C= 20-25, B= 15-20

Local air pollution can be derived from many different sources including factories, cars, diesel trucks, power plants, windblown dust and smoke from wood stoves and backyard burning. Its health effect is determined by the concentration of different pollutants and the individual’s general health. Air pollution can also be transported in from long distances.   

“We can encourage Canadians to make lifestyle changes to reduce their risk,” says Stephen Samis, director of health policy for the Heart and Stroke Foundation of Canada, “but air pollution is a pervasive and unavoidable health risk for heart disease that all Canadians face – and most are unaware of its short and long-term impact.”

“Poor air quality represents a particular challenge for our aging population and those at increased risk of heart disease,” says Dr. Abramson. “It’s ironic that people who are recovering from − or are trying to prevent − heart disease by being physically active may actually be exposing themselves to more risk on bad air days if they head outdoors to be active.” 

Heart and Stroke Foundation Survey

The Heart and Stroke Foundation surveyed a national representative sample of 1,134 Canadians and found major discrepancies between people’s knowledge of the health effects of air pollution, and how that translated to personal action. While almost two-thirds (63%) believe air quality has a major effect on health, nearly the same number, six out of ten (61%), do not let smog advisories affect what they do outdoors. 

Although Canadians seem to make the connection between pollution and some major diseases, heart disease is grossly under-recognized. When asked to name diseases affected by air pollution, eight out of ten (82%) named respiratory diseases, three out of ten (34%) cancer, but only one out of ten (13%) heart disease.

It was only when air pollution was linked to smoking that Canadians appeared to understand the risk: 68% strongly agreed with the statement that “like smoking, air pollution is a risk for heart disease and stroke.” 

 Heart and Stroke Foundation Survey of Canadians



Name heart disease as a disease linked to air pollution (unaided)


Believe air quality has a major effect on the health of Canadians


Change outdoor activity due to smog alerts


Check the air quality in index in their community from time to time or daily


Results are considered accurate +3.1%, 19 times out of 20.

Part of the problem may be that many Canadians do not see air pollution as affecting their communities. Six out of ten Canadians (64%) believe the quality of air in their community is generally good to excellent, with the rates being highest among those living in the Prairie provinces (84%), Atlantic Canada (75%) and British Columbia (71%) and lowest in Quebec (59%) and Ontario (53%).  However, like smoking, there are no “safe” levels of air pollution and all parts of the country are experiencing some degree of increased risk. To make matters worse, Environment Canada has projected that between 2000 and 2015, air pollution levels will increase in all regions of the country.

It’s a winter and rural-problem, too

In the Heart and Stroke Foundation survey, seven out of ten (69%) Canadians thought air pollution tends to be worse during the summer. Only 3% recognized that air pollution is a year-round problem.  

During the winter months, wood-burning stoves and fireplaces can be sources of dangerous air pollution. Wood-burning stoves and fireplaces are responsible for 28% of fine particulate matter pollution in Canada; they can also release other important pollutants, such as carbon monoxide and volatile organic compounds. 

According to the Heart and Stroke Foundation survey, 44% of Canadians living in communities of less than 10,000, report having a wood stove, pellet stove or fireplace and of those, 70% say they use it daily or almost every day during the winter. 

“If Canadians choose wood-heating as their heat source, they should choose a stove that is approved by the Canadian Standards Association (CSA) or by the Environmental Protection Agency (EPA). They are built according to performance standards that aim at limiting harmful emissions,“ says Stephen Samis.

Heart and Stroke Foundation Recommendations

Community design, and how our “built environment” affects our physical activity and use of different types of transportation (and therefore emissions that contribute to pollution), is a critical piece of the puzzle. Information just released from Statistics Canada indicates that Canadians are more addicted to cars than ever. In 2007 the Heart and Stroke Foundation partnered with the Canadian Institutes of Health Research to launch a major $4.1 million research initiative to study how community design affects physical activity and, consequently, heart health. 

According to the Heart and Stroke Foundation poll, 95% of Canadians strongly or somewhat agree that “the government should do more to reduce air pollution.” 

“Environment Canada has made great strides by setting a Canada Wide Standard for particulate matter pollution” says Stephen Samis. “However, it is “now essential for our Governments to set policies that decrease emissions and reduce air pollution. Increased investments in public transit within urban centres, planning more neighbourhoods that encourage walking, and decreasing Canadians’ dependency on cars, among others, will not only address concerns about the environment, but may ultimately reduce the burden on our healthcare system.” 

The Foundation believes that governments can take action to reduce air pollution and its impact on heart disease by: 

  • Rolling out the national Air Quality Health Index (based on the Toronto, Nova Scotia and British Columbia pilots) in all parts of the country to give all Canadians access to easy to understand information on daily air quality and clear recommendations on when and how to limit their exposure. The AQHI is a scale designed to help you understand what the air quality around you means to your health.
  • Strengthening federal and provincial legislation governing air quality to ensure that emission controls truly result in cleaner air.
  • Providing public awareness and incentive programs to encourage consumer and industry action to reduce air pollution.
  • Increasing investments in public transit within and between urban centres across the country, including investments in high-speed rail in the Quebec City-Ottawa-Toronto-Windsor corridor, and between Edmonton and Calgary.  
  • Ensure that all wood burning stoves, fireplaces and fireplace inserts for sale in Canada conform to the particulate emission requirements of the Canadian standard and are well labeled to indicate compliance with the standard.  
  • Allocating at least 7% of federal transportation-related infrastructure spending to active transportation infrastructure that facilitates walking and cycling, to reduce auto dependency and air pollution. 
  • Working with developers to create neighbourhoods and communities that promote walking, cycling and decrease auto dependency.  

Canadians who want to send a letter to their government representatives on this issue will find a sample here.

The Heart and Stroke Foundation, a volunteer-based health charity, leads in eliminating heart disease and stroke and reducing their impact through the advancement of research and its application, the promotion of healthy living, and advocacy. 

NOTE: This press release constitutes the Heart and Stroke Foundation’s Annual Report on Canadians’ Health – there is no separate report document. 


Posted: Jan 28, 2008.