Chronic diseases and health promotion

Integrated chronic disease prevention and control

Community-based programmes

Over the past few decades international research has clearly shown that chronic noncommunicable diseases have their roots in unhealthy lifestyles or adverse physical and social environments. Risk factors like unhealthy nutrition over a prolonged period, tobacco use, physical inactivity, excessive use of alcohol, and psychosocial stress are among the major lifestyle issues. The entire population is at risk because of mass elevated risk factors in which individual susceptibility is enhanced by culture, economic factors, and the environment. Therefore, population risk should be amendable to change through communitywide strategies. The primary tool for implementing a population strategy of prevention is a community-based program. Community interventions use education or environmental change to promote and facilitate lifestyle and behavior changes needed to address a particular problem.

Integrated community-based intervention programmes are comprehensive packages in which different kinds of feasible activities are combined to produce a synergistic effect. The community approach in chronic disease prevention has a high degree of generalizability, cost-effectiveness due to the use of mass communication methods, ability to diffuse information successfully through use of community networks, and potential for influencing environmental, regulatory and institutional policies that shape health.

North Karelia in Finland and Stanford in the USA in the early 1970s provided the settings for the first real community intervention programmes, whose goal was to bring about social and health-oriented behavioural changes on several levels in the community - from the individual to the institutional and organizational levels.

North Karelia Project

In the early 1970's Finland had the greatest CVD mortality rate in the world. The North Karelia Project was started in 1972 as a national pilot and demonstration programme for CVD prevention. Reduction in the population levels of the well established risk factors (smoking, elevated cholesterol and elevated blood pressure) was the main intermediate objective. A comprehensive community-based intervention involving health services, NGO's, industry, media and public policy was used. After the initial period (1972-77), the project experiences have been actively used for comprehensive national heart health programme. Carefully conducted evaluation involving population surveys and disease registers have shown that the population risk factor levels have greatly reduced, and consequently the age-adjusted CHD mortality rate among 30-64 year old male population has reduced, from 1970 to 1995, by 73% in North Karelia and 65% in all Finland. Very favourable changes have also been shown with cancer and all cause mortality and the general health of the population. International collaboration, especially through WHO, will test similar approaches in other parts of the world and help control this major global disease burden.


Stanford Community Study

The Stanford Community Study was started in 1974. Information was broadcast via the mass media to the inhabitants in two towns with a total of 30,000 inhabitants, with the aim of reducing the fat content in the daily diet. Individual information was also provided in one of the two towns. A third town served as the reference. After two years of intervention - including intensive information campaigns and individual counselling - a reduction in the average fat content in diets of 25 grams per day was demonstrated in the two intervention areas, compared to three grams per day in the reference area. Similarly, a significant drop in the population's cholesterol count could be seen in both intervention areas.