“In the Healthy Communities Program it is the members of the community itself who promote the change of the health paradigm in their town”

DR. VALENTÍN FUSTER

“In the Healthy Communities Program it is the members of the community itself who promote the change of the health paradigm in their town”

DR. VALENTÍN FUSTER

HEALTHY COMMUNITIES Program

Hypothesis

In the Healthy Communities Program it is the members of the community itself who promote the change of the health paradigm in their town.

The current worldwide epidemic of cardiovascular diseases is the outcome of the consumerist society we live in. The major increase in the prevalence of these diseases must be addressed by means of multi-sector health promotion and primary prevention strategies that encourage a healthy lifestyle and reduce cardiovascular risk factors, morbidity and mortality.

Although mortality by cardiovascular diseases has decreased in the developed countries, also confirmed in Spain, the combination of factors such as the population’s greater life expectancy, increased patient survival after a cardiovascular event, or city development and its derived effects (such as a sedentary lifestyle, obesity, changing eating habits and smoking) keep the prevalence of these diseases high [1, 2]. In view of the situation, we must focus our efforts not only on the treatment of cardiovascular disease, but also on primary prevention by means of multi-sector strategies to promote health and healthy lifestyles. Thus, the experts hold that community intervention programs promoting integrated health may have a significant impact on cardiovascular health [3, 4].

Individual and collective cardiovascular health

Active
living

Healthy
eating

Emotional
well-being

Prevention of
tobacco and alcohol

3-5 Years
SI! PreeSchool

6-11 Years
SI! Primary

12-16 Years
SI! Secondary

17-24 Years
Fifty Action

25-50 Years
Fifty-Fifty

51-66 Years
Fifty Plus I

+67 Years
Fifty Plus II

The Healthy Communities Program, implemented in collaboration with the City Council of Cardona, aims to promote the development of healthy lifestyles throughout all stages of life and to contribute to promoting quality of life, correcting health habits and self-management of the main risk factors for cardiovascular diseases, such as overweight, obesity, physical inactivity, blood pressure and smoking [4, 5].

Consequently, the aim is to turn Cardona (Barcelona, Spain) into a healthy city, that means, a city that prioritizes the health of its inhabitants in all its actions, including the creation of physical (healthy urbanism) and social environments (environment) that promote health. The idea is to be able to create a replicable model for the development of healthy municipalities. During the pilot phase of the project community activities were organized, involving the residents of Cardona according to their capacities, conferences about health were organized and motivational workshops were held by “health promoters”, trained specifically for the program, to promote healthy lifestyles [1, 4].

Moreover, Cardona’s program included an ambitious urban development plan designed to provide an atmosphere that promotes physical activity among the population. In this pilot study approximately 10% of the city population was longitudinally assessed in years 2014 (beginning of the pilot study), 2016 (impact of pilot health promotion activities) and 2018 (sustainability, end of the pilot study). Preliminary results were promising and showed in the first 18-month period (intervention period) a trend toward improvement of their health scores, mainly driven by improvements in the physical activity and dietary components. These findings justified the development of the next stage of the project in which the impact of the creation of a Healthy City will be appropriately tested through a quasi-experimental study design and relevant outcomes, so the model could be accepted and replicated elsewhere: Healthy Communities 2030.

By promoting a more active lifestyle, the Healthy Communities Program (HC-2030), launched in fall 2021, should encourage people to make healthier decisions about how they move, what they eat and how they use the environment around them and also provide opportunities to improve mental health and happiness

We hypothesize that a healthy city will impact positively to their inhabitants by improving cardiovascular health and physical activity indices, mental health and wellbeing. For such a purpose, a controlled longitudinal community-based intervention study will be carried out on 2,000 participants (1,000 in the intervention, which is Cardona, and 1,000 in the control town, which is Sallent) 12 years or older over a period of 5 years.

The primary endpoint will be the between group (intervened town vs control town) difference for the change in the Fuster-BEWAT score [4] which consists of a 0-15 scale for behaviors/health factors related to blood pressure, exercise, weight, alimentation (diet), and tobacco use (smoking).

The Healthy Communities Program is a multidisciplinary health-promotion initiative. The project will result in a toolkit for a community-driven health promotion intervention that could be replicated in cities and towns both nationally and internationally. The core of the intervention will be based on the previous health promotion programs developed and evaluated by the Science, Health and Education (SHE) Foundation: the SI! Program for children [5,6,7], and the Fifty-Fifty Program for adults [4,8,9,10].

The effect of these interventions was proven through randomized trials and the results were published in high-impact journals (Journal of the American College of Cardiology, American Heart Journal, American Journal of Medicine, etc.).

References

  1. Castellano JM et al. Rev Esp Cardiol. 2014, 67(9):6. Promoción de la salud cardiovascular en tres etapas de la vida: nunca es demasiado pronto, nunca demasiado tarde.
  2. Villar Álvarez F et al. Med Clin (Barc). 1998, 110:6. Mortalidad cardiovascular en España y sus comunidades autónomas (1975-1992).
  3. Fuster V. Arch Cardiol Mex. 2010, 80(4):261-71. Science, health and education: a priority and a model.
  4. Gomez-Pardo E, Fuster V et al. J Am Coll Cardiol. 2016, 67(5):476-85. A Comprehensive Lifestyle Peer Group-Based Intervention on Cardiovascular Risk Factors: The Randomized Controlled Fifty-Fifty Program.
  5. Penalvo JL, Fuster V et al. J Am Coll Cardiol. 2015, 66(14):1525-34. The SI! Program for Cardiovascular Health Promotion in Early Childhood: A Cluster-Randomized Trial.
  6. Céspedes J, Fuster V et al. Am J Med, 2013, 126(1):27-35.e3.Targeting preschool children to promote cardiovascular health: cluster randomized trial.
  7. Fernandez-Jimenez R, Fuster V et al. J Am Coll Cardiol, 2019, 73(16):2011-2021. Child Health Promotion in Underserved Communities: The FAMILIA Trial
  8. Latina J, Fuster V et al. Am Heart J, 2020; 220:20-8. Grenada Heart Project–Community Health ActioN to EncouraGe healthy BEhaviors (GHPCHANGE): A randomized control peer group–based lifestyle intervention.
  9. Fernández-Jiménez R, Fuster V et al. J Am Coll Cardiol, 2019, 75: 1 (42-56). Different lifestyle interventions in adults from underserved communities. The FAMILIA Trial.
  10. Fernández-Alvira JM, Fuster V et al. Am Heart J, 2021; 240:81-88. The challenge of sustainability: Long-term results from the Fifty-Fifty peer group-based intervention in cardiovascular risk factors.