EDITORIAL * EDITORIAL
The federal-provincial Canadian Heart Health Initiative Canadian Heart Health Surveys Research Group* T he six papers in the special supplement of this issue of CMAJ constitute an overview of the main findings of the provincial heart health surveys, which were carried out between 1986 and 1990 as part of the federal-provincial Canadian Heart Health Initiative. Data on risk factors for cardiovascular disease were gathered in each province from a sample of over 2000 men and women aged 18 to 74 years. The surveys also collected information about the participants' knowledge of the causes and consequences of cardiovascular disease. The participants constituted a stratified probability sample of the population (not including those in institutions) and were selected according to a statistical sampling design. All surveys followed a common standardized core protocol. The results reported in the special supplement refer to data from nine provinces. The 10th survey, the Ontario Heart Health Survey, is now in progress. A number of heart health demonstration programs are already under way in Ontario and in other provinces. The Canadian Heart Health Initiative is a vivid example of how epidemiologic research can lead to the development of programs and policies that address the main cause of death in industrialized countries. The initiative is a collaborative endeavour between provincial departments of health and the
Department of National Health and Welfare to implement a national strategy for cardiovascular disease prevention. The Heart and Stroke Foundation of Canada is a major partner. The origin of this approach to cardiovascular disease prevention lies in a report prepared in 1987 by the Federal Provincial Working Group on Cardiovascular Disease Prevention and Control.' The working group recognized the importance of developing a comprehensive epidemiologic database as a basis for goal-setting and as a baseline for future program evaluation. All provincial departments of health have committed themselves to the development of a database on cardiovascular risk factors and to the implementation of heart health demonstration programs in their jurisdictions. Both aspects are seen as phases in a longer term plan involving evaluation of the provincial heart health programs and the initiative as a whole, as well as the diffusion of experience in interventions.2 The collection of their own data on risk factors has helped provincial departments of health to play a leading role in the promotion of the heart health agenda. The provincial public health and health promotion systems are acting as catalysts in establishing coalitions to implement community heart health programs. Today, a myriad of organizations
*Chris Balram, PhD, Department of Health and Community Services, Fredericton, NB; Philip W. Connelly, PhD, University of Toronto, Toronto, Ont.; Dale Gelskey, MD, MPH, DPH, Cadham Provincial Laboratory, Winnipeg, Man.; Kevin Hogan, MD, Dr. Charles A. Janeway Child Health Centre, St. John's, Nfld.; Michel Joffres, MD, PhD, Department ofHealth, Edmonton, Alta.; Richard Lessard, MD, Department of Community Health, Laval University, Saint-Foy, Que.; Sharon MacDonald, MD, FRCPC, University of Manitoba, Winnipeg, Man.; David R. MacLean, MD, MHSc, Dalhousie University, Halifax, NS; Ella MacLeod, RN, Prince Edward Island Heart Health Program, Charlottetown, PEI; Makund Nargundkar, MSc, MEng, Statistics Canada, Ottawa, Ont.; Brian A. O'Connor, MD, MPH, North Shore Health Department, Vancouver, BC; Andres Petrasovits, PhD, MPH, Department of National Health and Welfare, Ottawa, Ont.; Bruce Reeder (chairman), MD, MHSc, FRCPC, University of Saskatchewan, Saskatoon, Sask.; Sylvie J.. Stachenko, MD, MSc, FCFP, Department of National Health and Welfare, Ottawa, Ont.; T. Kue Young, MD, MSc, FRCPC, University of Manitoba, Winnipeg, Man. Reprint requests to: Dr. Andres Petrasovits, Chief, Cardiovascular Disease Prevention Unit, Department of National Health and Welfare, Finance Annex, Rm. 290, Ottawa, ON KIA OL2 -
For prescribing information see page 2062
CAN MED ASSOC J 1992; 146 (1 1)
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are participating in these coalitions nationally, provincially and locally. They work much like a set of interconnected cogwheels. The Canadian Heart Health Network, provincial heart health networks and the Conference of Principal Investigators of provincial heart health programs interact with the federal and provincial health departments, the Heart and Stroke Foundation of Canada and its provincial affiliates, numerous professional, academic and voluntary organizations, and the private sector.2 The original protocol for the provincial heart health surveys was developed in Nova Scotia and later adopted as a core protocol by other provinces. Partial support for the surveys was provided by the National Health Research and Development Program of the Department of National Health and Welfare. Matching contributions were made by provincial departments of health, provincial health units and by some provincial affiliates of the Heart and Stroke Foundation of Canada. In each province the results of the risk factor surveys were reviewed by a data-interpretation committee, which verified the implementation of the survey methodology and assisted in assessing the implications of the survey results. After this review each provincial health department issued its report, which usually followed a standardized format. In all provinces, after the release of the heart health survey results the provincial health departments launched demonstration heart health programs and made a commitment to heart health as a priority. Technical coordination for this process at the national level was provided by the Department of National Health and Welfare. The core data from the surveys have been compiled into the Canadian Heart Health Database, the source of the results in this special supplement. The preparation of the papers was coordinated by the Canadian Heart Health Surveys Research Group and a core editorial group, both chaired by Dr. Bruce Reeder. The intent of the papers in the supplement is to provide a descriptive overview of the main findings. The six papers cover the following topics: methods, smoking, lipid levels, high blood pressure, obesity and multiple risk factors for cardiovascular disease.
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The last paper also reports on risk factor patterns by educational level and provides data on public knowledge and awareness of the causes and consequences of cardiovascular disease. The papers document comprehensively, for the first time in Canada, the magnitude of cardiovascular disease risk in the population. Once the information from the Ontario Heart Health Survey becomes available it will be possible to analyse and publish interprovincial comparisons of cardiovascular disease risk factors. Probably most striking is the finding that two in three Canadians have one or more of the major risk factors - smoking, high blood pressure and elevated blood cholesterol level. Clearly the population risk of heart disease is a major public health problem. The data provide estimates of the extent to which some risk factors are associated with others (e.g., obesity and high blood pressure, high blood pressure and elevated blood cholesterol level, and smoking and a sedentary lifestyle), pointing to the need for a multifactorial approach to prevention. It is worrisome to see an inverse association between educational level and prevalence of risk factors. Public knowledge of the causes of heart disease is low by most standards. The results of the provincial heart health surveys provide a compelling argument for the implementation of a comprehensive, multifaceted approach to the reduction of cardiovascular disease risk. This should combine strategies for cardiovascular disease prevention aimed at high-risk groups and health promotion interventions targeted at the whole population. The approach should promote intersectoral measures and marshall the energies of the different levels of government, the medical and other health care professions, researchers, voluntary associations and other stakeholders in the public and private sectors. It is a worthy challenge for the young Canadian Heart Health Initiative.
References 1. Promoting Health in Canada: Report of the Federal Provincial Working Group on Cardiovascular Disease Prevention and Control, Dept of National Health and Welfare, Ottawa, 1987 2. The Canadian Heart Health Initiative: a policy in action. Health Promot 1992; 30 (4): 1-19 (insert)
For prescribing information
see
page 2101
The federal-provincial Canadian Heart Health Initiative Canadian Heart Health Surveys Research Group* T he six papers in the special supplement of this issue of CMAJ constitute an overview of the main findings of the provincial heart health surveys, which were carried out between 1986 and 1990 as part of the federal-provincial Canadian Heart Health Initiative. Data on risk factors for cardiovascular disease were gathered in each province from a sample of over 2000 men and women aged 18 to 74 years. The surveys also collected information about the participants' knowledge of the causes and consequences of cardiovascular disease. The participants constituted a stratified probability sample of the population (not including those in institutions) and were selected according to a statistical sampling design. All surveys followed a common standardized core protocol. The results reported in the special supplement refer to data from nine provinces. The 10th survey, the Ontario Heart Health Survey, is now in progress. A number of heart health demonstration programs are already under way in Ontario and in other provinces. The Canadian Heart Health Initiative is a vivid example of how epidemiologic research can lead to the development of programs and policies that address the main cause of death in industrialized countries. The initiative is a collaborative endeavour between provincial departments of health and the
Department of National Health and Welfare to implement a national strategy for cardiovascular disease prevention. The Heart and Stroke Foundation of Canada is a major partner. The origin of this approach to cardiovascular disease prevention lies in a report prepared in 1987 by the Federal Provincial Working Group on Cardiovascular Disease Prevention and Control.' The working group recognized the importance of developing a comprehensive epidemiologic database as a basis for goal-setting and as a baseline for future program evaluation. All provincial departments of health have committed themselves to the development of a database on cardiovascular risk factors and to the implementation of heart health demonstration programs in their jurisdictions. Both aspects are seen as phases in a longer term plan involving evaluation of the provincial heart health programs and the initiative as a whole, as well as the diffusion of experience in interventions.2 The collection of their own data on risk factors has helped provincial departments of health to play a leading role in the promotion of the heart health agenda. The provincial public health and health promotion systems are acting as catalysts in establishing coalitions to implement community heart health programs. Today, a myriad of organizations
*Chris Balram, PhD, Department of Health and Community Services, Fredericton, NB; Philip W. Connelly, PhD, University of Toronto, Toronto, Ont.; Dale Gelskey, MD, MPH, DPH, Cadham Provincial Laboratory, Winnipeg, Man.; Kevin Hogan, MD, Dr. Charles A. Janeway Child Health Centre, St. John's, Nfld.; Michel Joffres, MD, PhD, Department ofHealth, Edmonton, Alta.; Richard Lessard, MD, Department of Community Health, Laval University, Saint-Foy, Que.; Sharon MacDonald, MD, FRCPC, University of Manitoba, Winnipeg, Man.; David R. MacLean, MD, MHSc, Dalhousie University, Halifax, NS; Ella MacLeod, RN, Prince Edward Island Heart Health Program, Charlottetown, PEI; Makund Nargundkar, MSc, MEng, Statistics Canada, Ottawa, Ont.; Brian A. O'Connor, MD, MPH, North Shore Health Department, Vancouver, BC; Andres Petrasovits, PhD, MPH, Department of National Health and Welfare, Ottawa, Ont.; Bruce Reeder (chairman), MD, MHSc, FRCPC, University of Saskatchewan, Saskatoon, Sask.; Sylvie J.. Stachenko, MD, MSc, FCFP, Department of National Health and Welfare, Ottawa, Ont.; T. Kue Young, MD, MSc, FRCPC, University of Manitoba, Winnipeg, Man. Reprint requests to: Dr. Andres Petrasovits, Chief, Cardiovascular Disease Prevention Unit, Department of National Health and Welfare, Finance Annex, Rm. 290, Ottawa, ON KIA OL2 -
For prescribing information see page 2062
CAN MED ASSOC J 1992; 146 (1 1)
1915
are participating in these coalitions nationally, provincially and locally. They work much like a set of interconnected cogwheels. The Canadian Heart Health Network, provincial heart health networks and the Conference of Principal Investigators of provincial heart health programs interact with the federal and provincial health departments, the Heart and Stroke Foundation of Canada and its provincial affiliates, numerous professional, academic and voluntary organizations, and the private sector.2 The original protocol for the provincial heart health surveys was developed in Nova Scotia and later adopted as a core protocol by other provinces. Partial support for the surveys was provided by the National Health Research and Development Program of the Department of National Health and Welfare. Matching contributions were made by provincial departments of health, provincial health units and by some provincial affiliates of the Heart and Stroke Foundation of Canada. In each province the results of the risk factor surveys were reviewed by a data-interpretation committee, which verified the implementation of the survey methodology and assisted in assessing the implications of the survey results. After this review each provincial health department issued its report, which usually followed a standardized format. In all provinces, after the release of the heart health survey results the provincial health departments launched demonstration heart health programs and made a commitment to heart health as a priority. Technical coordination for this process at the national level was provided by the Department of National Health and Welfare. The core data from the surveys have been compiled into the Canadian Heart Health Database, the source of the results in this special supplement. The preparation of the papers was coordinated by the Canadian Heart Health Surveys Research Group and a core editorial group, both chaired by Dr. Bruce Reeder. The intent of the papers in the supplement is to provide a descriptive overview of the main findings. The six papers cover the following topics: methods, smoking, lipid levels, high blood pressure, obesity and multiple risk factors for cardiovascular disease.
1916
CAN MED ASSOC J 1992; 146 (1 1)
The last paper also reports on risk factor patterns by educational level and provides data on public knowledge and awareness of the causes and consequences of cardiovascular disease. The papers document comprehensively, for the first time in Canada, the magnitude of cardiovascular disease risk in the population. Once the information from the Ontario Heart Health Survey becomes available it will be possible to analyse and publish interprovincial comparisons of cardiovascular disease risk factors. Probably most striking is the finding that two in three Canadians have one or more of the major risk factors - smoking, high blood pressure and elevated blood cholesterol level. Clearly the population risk of heart disease is a major public health problem. The data provide estimates of the extent to which some risk factors are associated with others (e.g., obesity and high blood pressure, high blood pressure and elevated blood cholesterol level, and smoking and a sedentary lifestyle), pointing to the need for a multifactorial approach to prevention. It is worrisome to see an inverse association between educational level and prevalence of risk factors. Public knowledge of the causes of heart disease is low by most standards. The results of the provincial heart health surveys provide a compelling argument for the implementation of a comprehensive, multifaceted approach to the reduction of cardiovascular disease risk. This should combine strategies for cardiovascular disease prevention aimed at high-risk groups and health promotion interventions targeted at the whole population. The approach should promote intersectoral measures and marshall the energies of the different levels of government, the medical and other health care professions, researchers, voluntary associations and other stakeholders in the public and private sectors. It is a worthy challenge for the young Canadian Heart Health Initiative.
References 1. Promoting Health in Canada: Report of the Federal Provincial Working Group on Cardiovascular Disease Prevention and Control, Dept of National Health and Welfare, Ottawa, 1987 2. The Canadian Heart Health Initiative: a policy in action. Health Promot 1992; 30 (4): 1-19 (insert)
For prescribing information
see
page 2101
