Part Three. What works: the evidence for action
Chapter Two. Review of effective interventions
Spotlight: Community-based projects in China
There have been several major community-based projects in China relating to chronic diseases. In China's third largest city, Tianjin, for example, a project was launched in 1984 aimed at reducing chronic disease risk factors at the community level. Activities included training health personnel, health education, health counselling and environmental changes. The nutrition project was integrated into the existing three-level health-care structure in the Tianjin project area without allocation of additional resources. Health workers were trained to increase their knowledge about the relationship between salt intake and blood pressure, and were taught how to give practical advice to patients on this issue.
The project also introduced environmental changes to promote healthy eating habits. Leaflets were distributed door-to-door, and posters and stickers were distributed to food retailers. Special measuring spoons were provided. Low sodium salt was also introduced, and the project cooperated with salt manufacturers and shops to ensure that this salt was available in the intervention area.
An outcome of the study was that residents in the intervention area had significantly better knowledge about salt intake than residents in an area not taking part. In the intervention area, average salt intake was significantly lower in men, and also reduced in women. In addition, there was a significant decrease in systolic blood pressure in the intervention area for both men and women. In contrast, both salt intake and systolic blood pressure increased significantly during the same period in men who did not take part.
In 1995, after comprehensive reviews by the Ministry of Health, Foreign Loan Office and the World Bank, a new project – the World Bank Loan Health VII: China Disease Prevention Project – was undertaken in seven cities, as well as some regions of Yunnan Province, covering a population of 90 million. It included activities in four fields: institutional development and policy reform, human resource development, surveillance and community intervention. Among the outcomes reported was a reduction in the prevalence of male adult cigarette smokers from 59% to 44%. In Beijing there were substantial increases in high blood pressure detection and treatment, and a fall in the death rates for both stroke and heart disease of more than 15% in the last year of the project.
Based on this experience, the Ministry of Health has established a total of 32 demonstration sites for chronic disease prevention and control across the country. Detailed interventions are determined and implemented by local health departments, according to local conditions. Notable outcomes so far have included a reduction in the annual heart disease and stroke deaths in those patients with high blood pressure who were being managed, from 1.6% to 0.8% between 2000 and 2002. In Shenyang, there was a reduction in the prevalence of adult smokers from 29% to 13% between 1997 and 2002 and an increase in the proportion of people participating in planned regular physical activity from 41% to 84% in the same period.