Heart of Mersey (HoM) CVD prevention programme

Background

Launched in 2003, Heart of Mersey (HoM) is based on the successful model of cardiovascular disease (CVD) prevention developed in North Karelia, Finland, and is a regional demonstration project for England with the World Health Organisation's Countrywide Integrated Non-communicable Diseases Intervention (CINDI).

The HoM CVD prevention programme works with a wide range of partners to achieve its aims through advocacy, lobbying, campaigns information and research. These roles are pivotal to improving heart health and reducing health inequalities. For example, the Merseyside Food Charter was developed to reward food providers offering nutritious, affordable and safe food. It has specifically been targeted at cafes, restaurants, hospitals, and schools. Its key objectives are:

• To increase the range and variety of healthy options/foods available for sale to the people of Greater Merseyside;
• To recognise the achievements and contributions of the food sector to improving the health of Greater Merseyside;
• To encourage and support the development of healthier options providing advice and guidance;
• To help HoM and its partners in motivating, informing supporting people to adopt healthier lifestyles; and
• To establish networks and links with different food service providers and also give them opportunities to share good practice.

What is the problem you are trying to solve?

HoM was formed to address the high levels of CVD in Merseyside. The Health Survey for Greater Merseyside (2003) revealed that, compared with the rest of England, Merseyside residents had:

• A higher prevalence of any cardiovascular disease (men 14.6% [from Merseyside] v 13.6% [from the rest of England], women 14.2% v 13.0%);
• A higher prevalence of heart attack (men 4.9% v 3.8%, women 2.0% v 1.7%);
• A higher smoking prevalence in women (27% v 24%), equally bad in men (27% v 27%);
• Higher total blood cholesterol levels in less affluent households (men 5.6 v 5.4 mmol/l, women 5.7 v 5.6 mmol/l);
• Lower blood levels of protective high density lipoproteins in men (1.3 v 1.4 mmol/l); and
• A higher prevalence of obesity among men and women in less affluent households (men 25.3% v 21.6%, women 29.9% v 29.1%).
• Important social gradients were seen in the majority factors.

It is crucial to reduce the inequalities gap for the population, who already experience high levels of deprivation.

What local organisations are involved?

We receive support from the five Primary Care Trusts (PCTs) of Greater Merseyside (Halton and St Helens, Knowsley, Liverpool, Sefton and Wirral) and Local Authorities (LAs) (Halton, Knowsley, Liverpool, Sefton, St Helens and Wirral), as well as health partnerships, the academic sector and voluntary organisations.

How many people are running this project and who are they?

There is a chief executive (Robin Ireland) and programme managers for the different programme areas: food (Modi Mwatsama), smoking (Eileen Streets), communications (Sue West), operations (Mike Parker) and research (Ffion Lloyd-Williams).

What local population are you targeting?

We are targeting the whole population of Greater Merseyside, especially children and adults living in the most deprived areas of Greater Merseyside.

How many people are you targeting?

1.8 million (the population of Greater Merseyside)

Interventions

What interventions are you using to address the problem?

The HoM programme aims to add value to local initiatives and programmes by working at area, regional, national and international levels to prevent coronary heart disease through integrated, evidence based interventions, and advocacy through lobbying.

As an intervention programme, HoM works in partnership with LAs, PCTs and health partnerships to support and enhance their CVD prevention initiatives.

There are also aims concerned with each of the risk factors for CVD: poor diet and smoking. The Food and Health Strategy, for example, involves joint working between the NHS, LAs and wider partners to build on the local food related strategies and activities in the Greater Merseyside area. It also provides direction for HoM when working with its many partners to implement the actions set out in the public health White Paper, Choosing Health: Making Healthier Choices Easier ¹ . The Smoke Free Programme is also behind the successful 4000 Reasons campaign highlighting the dangers of secondhand smoke in the workplace ² .

Is the project design based on evidence? If so, please state reference.

The HoM programme draws upon the principles of the successful CVD intervention programme in North Karelia. The North Karelia project based its working principles upon “…the application of medical and epidemiological knowledge to identify health problems and target risk factors for selecting intervention objectives, as well as behavioural and social knowledge for designing the actual programme content and activities… a strategy that integrates several innovative intervention approaches into a practical programme…” ³ .

Outcome

What outcomes or planned outcomes are you measuring?

The planned outcomes are: reduction in dietary fat intake; reduction in population level of serum total cholesterol (through reduction of saturated fat in diet); increase in fruit and vegetable consumption (up to five a day); reduced salt and sugar intake; and smoking behaviour.

Do you have any outcomes or results yet? If so, what are they?

The project is still ongoing, but we have seen positive short term outcomes for various projects being delivered, like Merseyside Food Charter and Smokefree NHS in Greater Merseyside. Information about all Heart of Mersey activities can be accessed on our website.

Is your project relevant to a government target or guideline?

The key aims are to reduce CVD deaths by 40% in the under-75s by 2010 and to reduce CVD incidence by 20% by 2010, as set out in the Department of Health’s Choosing Health: Making healthy choices easier ¹ .

Feedback

What obstacles did you have to overcome to set up this project?

The HoM programme developed out of a visit to Finland by a group of health professionals keen to discover why heart disease rates there had reduced dramatically in recent years. The group found that Finland's approach - a population wide intervention programme - resulted in a drastic reduction in saturated fat intake and CVD rates falling by 75%.

Initial funding was made available by the former Merseyside Health Action Zone and a Management Board was formed in spring 2002 from interested partner organisations including PCTs, LAs, the academic sector and voluntary organisations.

What have you learned about the project so far?

From its inception, HoM has recognised the importance of disseminating its key messages in relation to CVD risk factors, prevention and issues relating to the specific programme areas of food and smoking. Members of the HoM team regularly give presentations on HoM and the key messages around CVD prevention to a variety of audiences at the local, regional, national and international level.

Working with the media and maintaining a high profile for healthier lifestyles messages have been seen as key to the success of prevention programmes in Finland and elsewhere in the world and is a key priority for HoM. HoM has been able to build upon their media relations, enabling ongoing publicity of the programme and its activities.

HoM seeks to support and advises partners and local decision makers in different ways and community engagement is necessary to develop a lobby for change around the wider food agenda.

What would you do differently?

References:

1. Department of Health. Choosing Health: Making Healthy Choices Easier. 2004. www.dh.gov.uk (Search for 4135).
2. 4000 Reasons campaign. Available at www.4000reasons.org.uk (accessed 4 April 2007).
3. Puska P, Tuomilehto J, Nissinen A, Vartiainen E. The North Karelia Project: 20 Years’ Results and Experience. Helsinki, Finland: National Public Health Institute; 1995; 102: 33-34.