North Karelia, Finland•1972• After the first 25 years, the projectdemonstrated to have achievedchanges in smoking, BP and diet–CVD mortality reduced by 68%–CHD mortality reduced by 73%–All causes mortality reduced by 49%
North Karelia: Interventions•PHC providers involved in all aspects of the program•Involvement of community organizations and residents•Training and Media Communication•Environmental changes•Partnerships with food industry
CARMENConjunto de Acciones para laReducción Multifactorial deEnfermedades No transmisiblesConcerted actions to reducemultifactorial non- transmissibleor non-communicable diseases
PAHO: Country-Wide Actions1. National Plan of Action2. Policies3. Community-based actions4. Health service reorganization5. Integrated promotion and prevention actions6. Health equity focus7. Baseline and surveillance adapted to measure progress: Observatory
Observatory• Goal: support policy advocacy, development, monitoring and impact measurement• Canada, Brazil, and Costa Rica• Chile, Uruguay, Guatemala and Cuba and other Caribbean Countries (25+)• Benchmarks• Improve Surveillance
Effective Interventions• Tobacco taxes, smoking free areas and smoking cessation treatments• Transfat free America (Rio 2008)• Healthy meals in schools• Reduction of salt in diet• Increase physical activity• Community-based promotion• Improvement of PHC and referral services
Advocacy• “Program Dose” matters• Sustained efforts also matter• Integrated community based programs do work: – Health education – PHC services – Community involvement and participation• Not Surprised!