Chronic diseases and health promotion

Part Three. What works: the evidence for action

Chapter Two. Review of effective interventions

Community-based interventions

Community-based programmes for chronic disease prevention and control target a specified community. They focus on risk factor reduction, community mobilization and participation. Integrated community-based programmes aim to reach the general population as well as targeting high-risk and priority populations in schools, workplaces, recreation areas, and religious and health-care settings. They also enable communities to become active participants in decisions concerning their health, and promote simultaneous use of community resources and health services, as well as coordinating different activities by means of partnerships and coalitions.

Successful community-based interventions require partnerships between community organizations, policy-makers, businesses, health providers and community residents. Such interventions for chronic diseases in developed countries have demonstrated considerable potential for effectiveness in developing countries. Community-based interventions can also be the starting point for national improvement. Finland, featured earlier in this part, is a good example of how community-based programmes, once shown to be successful, can be scaled up to national level.

School-based interventions

School health programmes can be an efficient way of reducing risks among large numbers of children. They vary from one country to another, but almost all include four basic components: health policies, health education, supportive environments and health services. Such programmes often include physical education, nutrition and food services, health promotion for school personnel and outreach to the community.

Many school health programmes focus on preventing the risk factors associated with leading causes of death, disease and disability, such as tobacco, drug and alcohol use, dietary practices, sexual behaviour and physical inactivity. In comparative studies of public health interventions, the World Bank concluded that school health programmes are highly cost-effective. The annual cost of school health programmes was estimated to be US$ 0.03 per capita in low income countries and US$ 0.06 in middle income countries, respectively, averting 0.1% and 0.4% of the disease burden.