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@heart Newsletter / Vol. 1, No. 1 Spring, 1997


Contents

Welcome to the first issue of @heart

published by the Ontario Heart Health Resource Centre! We plan to publish this newsletter four times a year as a means of keeping everyone who is interested in heart health promotion up-to-date on news from around the province. The status of communities implementing heart health programs, developments at the Ministry of Health, heart health news from across Canada, and information about useful resources -- these all will be reported in @heart. We welcome your comments and input to future editions. Please send your comments, questions, story ideas, resource tips -- in fact, anything you think will help the cause of heart health in Ontario -- to The Editor, @heart, c/o The Heart Health Resource Centre, 486 Queen Street East, Suite 202, Toronto, Ontario, M5A 1T7.

Community-Based Cardiovascular Disease Prevention: The Opportunity and the Challenge

This issue of @heart includes a commentary from Dr. Roy Cameron, Professor with the Department of Health Studies and Gerontology at the University of Waterloo, and Director, Centre for Behavioural Research and Program Evaluation, National Cancer Institute of Canada. He is well known to the Ontario heart health community; he was senior consultant to the Ontario Heart Health Demonstration Sites from 1991 through 1995, and co-principal investigator for the Canadian Heart Health Initiative: Ontario Project (CHHIOP).

Cardiovascular disease (CVD) is the leading cause of death in Canada, accounting for 38% of all deaths in 1992. Many of these deaths were premature, with about 290,000 years of life lost under the age of 75. In 1993, the direct costs of CVD in Canada were $8.3 billion dollars. The Ontario health care system spends approximately $2 billion per year treating ischemic heart disease. Cardiovascular disease is costly to individuals, families, and society at large.

There is an enormous opportunity to improve this picture. Among adult Canadians, 63% have at least one of CVD's three major modifiable risk factors -- smoking, high blood pressure, or elevated cholesterol levels. In Ontario, more than 75% of adults exhibit at least one of the following modifiable risk factors for CVD: smoking, high cholesterol, high blood pressure, over weight, diabetes, sedentary lifestyle. Given our rather arbitrary definitions of high cholesterol, high blood pressure, etc., an even higher proportion of the population is in fact at elevated risk of CVD because of these risk factors.

Given that risk factors are so prevalent, we must find strategies for influencing the behaviour of large numbers of individuals if we are to achieve an improvement in the health of the population. We need to deliver educational programs in ways that enable us to reach and influence many people at low cost. Changing environments (social, policy, physical) may be a powerful strategy for reaching large numbers of people with sustainable interventions.

There is good reason to believe that major improvements in the health of the population can be achieved. Finland offers a particularly apt example of success. The North Karelia project was launched in 1972 in an attempt to reduce CVD in this area of Finland. During the next five years, total cholesterol and blood pressure showed more favourable change in North Karelia than in a comparison area; during 10 years, smoking was reduced more in North Karelia than in the comparison area. Later, as North Karelia's programs were disseminated to the rest of the country, there was a dramatic nationwide reduction in heart disease. CVD mortality declined by more than 50% in Finland between 1969 and 1992.

Much of this success was achieved through environmental change activities such as the training of health professionals and lay leaders, collaboration with food manufacturers and caterers, community development and advocacy for policy change at both local and national levels.

There is a tremendous need and opportunity to raise awareness of the potential for improvement in the cardiovascular disease picture. Knowledge of the prevalence of risk factors (or even what the risk factors are) is suprisingly low in the general public, even among the highly educated. For instance, among those with 12 or more years of education, only 49% listed smoking as a risk factor for heart disease.

Those of us working in heart health need to get the issue on the media agenda, the public agenda and the policy agenda. To reduce CVD, we need to get high-level decision-makers in our communities concerned about the magnitude of the problem and aware of the potential to make a difference. We need to work closely with those who are in a position to support environmental policy changes that can do much to improve the health of our population.

References used in the preparation of this article include the following documents. Copies may be borrowed from the Heart Health Resource Centre.

Heart and Stroke Foundation of Canada. Heart Disease and Stroke in Canada. Ottawa. 1995

Ontario Ministry of Health. Promoting Heart Health: Report of the Chief Medical Officer of Health. Toronto. 1993

Health Canada. Canadians and Heart Health: Reducing the Risk. Ottawa. 1995.

Rose, G. The Strategy of Preventive Medicine. New York: Oxford University Press. 1992

Vartiainen, E., et al. Twenty-year trends in coronary risk factors in North Karelia and in other areas of Finland. International Journal of Epidemiology 1994; 23: 495-504

Puska, P., et al. Mortality changes. In: Puska, P., Tuomilehto, J., Nissinen, A., & Vartiainen, E., (eds). The North Karelia Project: 20 Year Results and Experiences. Helsinki, Finland: National Public Health Institute. 1995, pp. 159-167

MacDonald, S., Joffres, M.P., Stachenko, S.J., et al. Multiple cardiovascular risk factrors in Canadian adults. Canadian Medical Association Journal, 1992; (11 suppl):2021-2029. Cited in Heart and Stroke Foundation of Canada, Heart Disease and Stroke in Canada. Ottawa. 1995

Dearing, J., & Rogers, E. Communication Concepts 6: AGenda-Setting. Thousand Oaks, California: Sage Publications Inc. 1996.

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@Sudbury:
Heart Health/Coeur en santé, publishes new resource

Sudbury Heart Health/Coeur en santé has help for communities intending to launch community-based heart health initiatives.

Shifting the Health Culture of a Community offers a community stories package and evaluation report that focuses on Sudbury's experiences as one of Ontario's five Ontario Heart Health Action Program demonstration sites. It will be of particular interest to communities that are passed the "awareness" stage and starting out and want to take a strategic look at their heart health programs. Copies will be available in May, and may be obtained from either Sudbury Heart Health/Coeur en santé or from the Ontario Heart Health Resource Centre for a cost of $49.95.
For more information, call (705) 671-9544.

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@Brant, Haldimand-Norfolk:
Policy Guides ready for distribution

Policy guides designed to help individuals influence organizations to develop and implement healthy heart policies will be distributed in Brant, Haldimand-Norfolk beginning in April.

The three guides -- titled Heart Healthy Step in the Right Direction -- are aimed specifically at schools, community groups and work places. Each provides a rationale for implementing heart healthy policies and provides community stories dealing with the three behavioural risk factors -- smoking, physical inactivity and poor nutrition. The guides will be distributed primarily through Heart Health partners and health department contacts.

According to Margot Fournier of the Haldimand-Norfolk Health Department, the policy guides are intended to provide a starting point for community partners and individuals who wish to carry on the work of the Heart Health demonstration project. "Working with people to affect policy change does not require significant financial resources, so this seems like a logical next step," she added.

Plans for evaluating the guides are not final, but followup with recipients of the guides is likely.

For more information, contact the Haldimand-Norfolk Health Department at (519) 426-6170.

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@Brant, Haldimand-Norfolk:

Quality physical activity is in the bag -- that is, the box! Before the end of this school year, children in Brant County and the Regional Municipality of Haldimand-Norfolk will receive a very precious treasure -- the promise of better heart health for future generations! Following a successful pilot project in February, every primary school will receive a large plastic storage tub called "Heartly's Treasure Chests," in honour of the Brant, Haldimand-Norfolk Heart Health project mascot. Each chest contains a wealth of materials to help classroom teachers provide quality daily physical activity for children in Grades 1-3. Each box contains activity resources not normally found in the classrooms, including rhythm sticks, juggling scarves, metre-long ribbons, felt squares, and activity dice -- large cubes with pictures and words that are thrown to select an activity. The items are "classroom friendly" and designed to allow all children to participate. The February pilot project in six schools proved the value of the Treasure Chest. Because teachers and school boards were involved in developing the resource, and because it is based on the common curriculum, teachers reported that it was very easy to incorporate activities into the classroom's daily routine. And, they said, the children loved it! Partners in developing Heartly's Treasure Chest were: Brant County Health Unit, Haldimand-Norfolk Health Department, Brant, Haldimand-Norfolk Heart Health, Ontario Physical Health Education Association (OPHEA), YM/YWCA, Boards of Education, Heart and Stroke Foundation, Parks and Recreation Departments, Active Living Canada, Haldimand-Norfolk Active Living Network, local businesses and equipment suppliers. For more information, contact the Haldimand-Norfolk Health Department at (519) 426-6170. [Contents]

Heart disease and stroke only strike men, right?

Wrong! The sad fact is that they affect almost as many women as men in Canada every year -- in fact, they are the leading cause of death and disability among women. However, a survey by the Ottawa-Carleton Health Department indicated that only 11 per cent of women realize this as a major health concern. The good news is that many of the risk factors that lead to heart disease in women can be reduced through lifestyle changes. The Ottawa-Carleton Health Department and Ottawa-Carleton Heart Beat have taken up the challenge to raise awareness of the issue and provide support for community change. Activities include:

  • the commitment of local agencies and groups to address the issue of women and heart health through collaborative events and activities
  • the establishment of a Regional Heart Beat Advisory Committee on Women and Heart Health, to profile the issue and support women and heart health initiatives
  • the "Everyone's a Winner Contest," co-sponsored by the Ottawa-Carleton Health Department and Loeb Stores in the region
  • the Ottawa-Carleton Health Department's "Your Heart is in Your Hands" February bus and poster campaign
  • the Annual Heart and Stroke "Women and Heart Health" Breakfast in January
  • the development and distribution of more than 5,000 "Women and Heart Health" resource kits.
  • the creation of a "Women and Heart Health" Heart Beat Quilt
  • community newspaper articles and a March media event.
February -- Heart Month -- provided an effective vehicle for kicking off many of these activities, and their success has encouraged all the partners to plan additional activities for the rest of 1997. The focus also provided an opportunity for many programs within the health department to work together. For information, contact Karen Bays-Woods or Lisa Sullivan at (613) 722-2328 (ext. 3755).

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@Central West Health Planning Information Network:
Community needs assessed by seven public health units

The lifestyle managers of the seven public health units in the Central West Health Planning Information Network (CWHPIN) have formed a working group to assess the need for heart health and cancer prevention in each of their local planning districts.

CWHPIN is assisting the seven health departments by completing profiles of "comparative" need for each district. Each health unit will then assess "expressed" needs within the district, and conduct extensive telephone surveys with the public to determine "felt" needs.

(Comparative needs are measures of lowered health status or of factors associated with lowered health status. Expressed needs, also known as demands, are those that can be measured by observing actions such as the formation of an advocacy group, unsolicited telephone calls, letter writing campaigns, etc. Felt needs measure the extend to which people indicate, when prompted, that they want a particular program or service, or wish to deal with a particular issue. Felt needs become expressed needs once the individual or group takes some action to achieve its ends.)

The survey to determine felt needs will assess the "stage of change" for each respondent with respect to the three major risk factors; assess the channels through which the individual would prefer to receive information; examine community beliefs about heart health and cancer prevention; and collect a broad range of demographic information.

Results of the survey should be available in late June and will be used by the seven departments to plan future heart health activities.

For information: JoAnn Heal, CWHPIN, (905) 570-9952.

Surgeon General endorses physical activity's link to heart health

" . . . regular physical activity greatly reduces the risk of dying from coronary heart disease, the leading cause of death in the United States."

That quote is from the U.S. Surgeon General's first-ever report on physical activity and health. Issued just prior to last summer's Olympic Games in Atlanta, Georgia, the report is now available on the Internet at www.cdc.gov/nccdphp/sgr . It provides encouraging reading for everyone involved in heart health.

The report's major conclusions include the following:

  • People of all ages, both male and female, benefit from regular physical activity.
  • Significant health benefits can be obtained by including a moderate amount of physical activity on most, if not all, days of the week. Through a modest increase in daily activity, most Americans can improve their health and quality of life.
  • Physical activity reduces the risk of premature mortality in general, and of coronary heart disease, hypertension, colon cancer, and diabetes mellitus in particular.
  • Research on understanding and promoting physical activity is at an early stage, but some interventions to promote physical activity through schools, worksites, and health care settings have been evaluated and found to be successful.

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OPHEA workshops provide ideas for encouraging active children

OPHEA provides a wide range of workshops for organizations and individuals looking for new "active living" ideas and programs for children and youth. Each workshop focuses on helping children and youth develop a love of being active.

 Delivered through 10 regional workshop leaders, the workshop topics are:
. Physical Activity and the Very Young Child
. Healthy Child Development Through Sport
. Quality Daily Physical Education
. Limited Space Activities
. Gender Equity in Physical Activity/Physical and Health Education
. Quality Programming in Physical Activity (a customized blend of the previous five)

For more information, contact OPHEA at 1185 Eglinton Ave. E., Suite 501, North York, Ontario, M3C 3C6; Tel: (416) 426-7120; Fax: (416) 426-7373; e-mail: ophea@osrc.com

@heart
Vol. 1, No. 1 Spring, 1997
A newsletter from Ontario's Heart Health Resource Centre

@heart is published four times a year to provide up-to-date heart health news from around the province for anyone who is interested in heart health promotion. The status of communities implementing heart health programs, developments at the Ministry of Health, heart health news from across Canada, and information about useful resources will be reported in @heart.

@heart is published by the Heart Health Resource Centre, c/o Ontario Public Health Association, 468 Queen Street East, Suite 202, Toronto, Ontario, M5A 1T7. You may telephone us at (416) 367-3313, or toll-free at 1-800-267-6817. Our fax number is (416) 367-2844, and you may reach us by e-mail at heart@web.net.

  • @heart production:
    • WordTrade Public Relations Inc., Toronto
    (Design by the Graffic Link Design Studio, Brantford)

Your comments and suggestions are appreciated. Please address all correspondence to the Editor, @heart, at the above address.

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