RHP&EO is the electronic journal of the International Union for Health Promotion and Education

 

Four Generations Of Cardiovascular Prevention: From Clinical Preventive Medicine To The New Public Health

Charli Eriksson

National Institute of Public Health, Box 27848, 8-11593 Stockholm, Sweden

An on-going assessment of community-based cardiovascular prevention motivated a review of the different approaches, previously described in three generations. Four differ generations or phases may be differentiated due to different focus and scope with regard to intervention methods, evaluation designs and outcome measures. Moreover, the generations of cardiovascular prevention have different emphasis with regard to effects on individual and community or population level. Within each generation a basic model and an extended model using a broader and a more appropriate theoretical base for the intervention may be separated.

  1. The clinical generation, mainly during the 60's, consists of treatment of a single risk factor such as hypertension or hyper-cholesterolaemia. Individuals with high risks were identified and treated with mainly drugs.

  2. The bio-epidemiological generation, based on the notion of several related risk factors' behind cardiovascular diseases, uses the multiple risk factor approach. These trials include large groups of people and the outcome is measured in total and cardiovascular mortality. The community intervention trial are advanced programs using intervention and reference areas as well as combinations of high risk and population approaches.

  3. The socio-epidemiological generation includes small-scale, act/on-oriented, community-based and multiple risk factor approaches. The emphasis is on local inter-sectorial cooperation and empowerment of people.

  4. The policy and environmental generation, rediscovering the roots to the first revolution in public health, is focused on the societal processes that impair the public health. The supportive environments and healthy public policies are central 'concepts in the new public health.

 


Copyright © 1999-2001 Reviews of Health Promotion and Education Online,
Last modified: October 07, 2000

Internet Explorer 5.0 or later version gives the optimal visual effect of this website.