Five very convincing community initiatives demonstrated significant improvement in heart health - in both short and long term.
What does it take to create successful results?
Community involvement and political commitment are crucial for positive results. Political commitment must ensure that the overall environment is supportive of health promotion. For example politicians must take responsibility for smoke free public and workplaces, urban planning which encourages physical activity, healthy school meals and proactive primary care which reaches out to the disadvantaged population groups.
Community initiatives must secure buy in from the people. Health interventions must be relevant to people and they must have influence on the design and implementation.
An essential part of any intervention is the recognition of social justice. It is the people from the lower socio-economic groups who suffer the most from cardiovascular diseases. Life circumstances, such as inability to work, unemployment, low professional qualifications and laborious jobs with low control, make it very difficult for these people to engage in health. Therefore, in order to promote health you must address social injustice.
All 5 initiatives included both a high risk and a population approach acknowledging that it is not an `either or` but a `both and`.
An economic analysis showed that community interventions were very cost effective.