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Community-based intervention studies in high-income countries 

Community-based intervention studies in high-income countries
Community-based intervention studies in high-income countries

Pekka Puska

and Erkki Vartiainen

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date: 19 May 2022

After World War II, with the emergence of cardiovascular and some other chronic disease epidemics and with increasing medical evidence on their risk factors, preventive efforts in many industrialized countries included community-based preventive programmes, projects, and studies. An important background was the notion that the strong risk factors relate closely to behaviours and lifestyles—especially to diet and smoking. It was also realized that in order to reduce the disease rates in the population, merely working with individuals with ‘clinically high risk’ is insufficient. Instead, to reduce the disease rates, a population-based approach is needed, i.e. changes in general lifestyle and reduction of general risk factor levels in the population.

The first major community-based project was the North Karelia Project in Finland, which was started in 1972 to plan, implement, and evaluate a comprehensive preventive cardiovascular preventive programme in this population with a very high mortality from cardiovascular diseases. Based on similar concepts, and later with the encouraging experiences from the North Karelia Project, many other community-based projects were started, with somewhat different background and approaches.

Today, many evaluation results and experiences are available about numerous community-based intervention studies in high-income countries. However, the results of the specific studies have not matched with the initial optimism. On the other hand, the results of the North Karelia Project and other community-based studies show the great potential of long-term, sustained, and comprehensive interventions.

The chapter describes some of the major community-based studies in high-income countries. It discusses further the many challenges of the design of such intervention studies and their evaluation. Despite many constraints, modern public health is very dependent on interventions on the main, well-established chronic disease risk factors in the community and in the national population. Community-based programmes have also helped to develop national policies and activities. At the same time further development in both our concepts, methods, and measurements with community-based interventions will be important to better serve public health.

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