Friday, September 01, 2006

Promoting Health of a Specific Problem

Cardiovascular Disease is one of the most pressing health problems faced in the Western worls, so it is not surprising to find that significant amount of health promotion activities are focused on this problem. The first major community-wide program for the prevention of cardiovascular disease started in 1972 in North Karelia, a mostly rural county in eastern Finland with 180,000 inhabitants (Puska, 1984). This county had a very high rate of cardiovascular disease due to the high-risk behaviors of its inhabitants. The Finnish government organized a program that aimed at (1) reducing smoking, serum cholesterol levels, and blood pressure through mass health communication; (2) organising individual and group services; (3) training local health oersonnel; and (4) bringing about changes in the environment. The program also sought to avoid fear appeals and to emphasize practical ways to accomplish behavior changes.

The initial evaluation, which occurred five years after the project started, compared the residents of North Karelia to those of another county in eastern Finland. Five years is not long enough to show reductions in cardiovascular morbidity and mortality, but it is sufficient time to demonstrat changes in CVD risk factors, such as cigarette smoking, serum cholesterol, and systolic and diastolic blood pressure. The five-year follow-up showed that health-related behaviors of North Karelia residents changed in the desired diretion. Middle-aged men experienced a 17.4 %greater decrease in cardiovascular risks and women an 11.5% greater decrease compared to the comparison county. A 10-year evaluation showed maintenance or further decreases in these target factors, with the result that men in North Karelia experienced a 22% decrease in cardiovascular mortality; the men in the comparison county experienced only a 12% decrease (Puska, 1984). Furthermore, the rate of disability payments for cardiovascular disease changed, and five years into the program North Karelia had a 10% lower rate of payment for cardiovascular disabilities than the comparison region. This savings more than paid for the entire community intervention programme.

A similar approach was adopt in the Stanford Five-City Project. In this project, two communities received educational intervention, and three cities served as controls. The goal of the project has been to stimulate and maintain lifestyle changes that result in a community-wide reduction of cardiovascular disease. Farquhar et al. (1990) reported on a fiveyear follow-up study that found small but significant decreases for two treatment cities in cholesterol levels, resting pulse rate, and blood pressure. The smoking cessation rate was an impressive 13% greater in the intervention cities than in the control cities. In addition, the treatment cities showed greater decreases in overall mortality rates and risk factor scores for coronary heart disease.

What we can conclude from these studies is that mass appeal campaigns at a target audience for a specific health problem do seem to have significant positive effects on the health behaviours being focused upon. It would also seem that this is a cost-effective way of promoting health in regards to cardiovascular disease.


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