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Scandinavian Journal of Public Health
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Can a sustainable community intervention reduce the health gap? -10-Year evaluation of a Swedish community intervention program for the prevention of cardiovascular disease

Lars Weinehall

Epidemiology, Department of Public Health and Clinical Medicine, UmeÅ University, UmeÅ, Sweden, Lars.Weinehall{at}epiph.umu.se

Gideon Hellsten

Norsjö Primary Health Care Centre, Norsjö, Sweden

Kurt Boman

Epidemiology, Department of Public Health and Clinical Medicine, UmeÅ University, UmeÅ, Sweden, Department of Medicine, SkellefteÅ County Hospital, SkellefteÅ, Sweden

Göran Hallmans

Nutritional Research, Department of Public Health and Clinical Medicine, UmeÅ University, UmeÅ, Sweden

Kjell Asplund

Internal Medicine, Department of Public Health and Clinical Medicine, UmeÅ University, UmeÅ, Sweden

Stig Wall

Epidemiology, Department of Public Health and Clinical Medicine, UmeÅ University, UmeÅ, Sweden

Objectives: This paper evaluates the 10-year outcomes of a Northern Sweden community intervention program for the prevention of cardiovascular disease (CVD), with special reference to the social patterning of risk development.

Methods: Using a quasi-experimental design, trends in risk factors and predicted mortality in an intervention area (Norsjö municipality) are compared with those in a reference area (Northern Sweden region) by repeated independent cross-sectional surveys.

Results: There were significant differences in changes in total cholesterol level and systolic blood pressure between the intervention and reference populations. The predicted coronary heart disease mortality (based on the North Karelia risk equation), after adjustment for age and education, was reduced by 36% in the interventionarea and by 1 % in the reference area.

Conclusions: We conclude that a long-term community-based CVD prevention program which combines population and individual strategies can substantially promote a health shift in CVD risk in a high risk rural population. When evaluated for different social strata, we found no signs of an increasing health gap between socially privileged and less privileged groups. Socially less-privileged groups benefited the most from the present prevention program.

Key Words: cardiovascular disease • community intervention • health promotion • prevention • primary health care • social factors.

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Scandinavian Journal of Public Health, Vol. 29, No. 56 suppl, 59-68 (2001)
DOI: 10.1177/14034948010290021901
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