Intended for healthcare professionals


Effects of the Heartbeat Wales programme

BMJ 1999; 318 doi: (Published 17 April 1999) Cite this as: BMJ 1999;318:1072

Programme that originated in Finland should be adopted

  1. Simon Capewell, Senior lecturer (,
  2. James McEwen, Head of department,
  3. James Dunbar, General practitioner,
  4. Pekka Puska, Head of department
  1. Department of Public Health, University of Glasgow, Glasgow G12 8RZ
  2. Downfield Surgery, Dundee DD3 8NE
  3. KTL National Public Health Institute, FIN 00300, Helsinki, Finland
  4. Department of Public Health and Community Medicine, University of Sydney, NSW 2006, Australia
  5. University of Bristol, Department of Social Medicine, Bristol BS8 2PR

    EDITOR—We agree with Ebrahim and Davey Smith that contamination of the “control” area in the Heartbeat Wales programme seems likely. 1 2 The aetiological evidence for coronary heart disease is now well established—principally smoking, poor diet, raised cholesterol concentrations, hypertension, and poverty.3 This risk factor model helps to explain the trends within countries and the large differences between countries. 3 4 But how can we achieve the 10-fold lower mortality from coronary disease that is seen in Japan and France?

    Ebrahim and Davey Smith suggest that, in isolation, the effectiveness of all community based interventions is low.2 Might it therefore be useful to examine the bigger picture? In Finland mortality from coronary heart disease has dropped by 73% in North Karelia and by 65% elsewhere.5 Why is this more than twice the fall in Britain, a country with similar cardiovascular epidemiology?

    In Finland a comprehensive, integrated programme of prevention and treatment started in 1972 in North Karelia and extended to the rest of Finland five years later. …

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