HEALTH PREVENTION WORK IN NORSJÖ

In the late 1970s, cardiovascular disease was much more common in Västerbotten County than in the rest of Sweden. Norsjö municipality in Västerbotten had the highest mortality from AMI and strokes in the country.

In early 1985, the Norsjö model, a local Swedish intervention model, was launched by the Västerbotten County Council to achieve health-promotion co-operation in the local community.

In the Norsjö model, the entire local community (ie authorities, organisations and individuals) worked together to influence the health of the local population. The project, it was decided, would continue for at least 10 years.

The community intervention in Norsjö combined individual- and population-oriented efforts. The individual efforts were carried out by primary-care providers. The work included a yearly health survey and individual counselling. The population-oriented efforts were carried out by, for example, clubs, media, grocery stores and government businesses.
The health survey concerned itself with the individual’s own risk factors (high lipids, high blood pressure, smoking, impaired glucose tolerance and overweight) while the efforts directed towards the public were about how food, exercise, smoking and stress habits could be altered to promote health.

All efforts focused on making people understand that changing your lifestyle meant better health. ‘It’s better that many change a little than for a few to change a lot’. This slogan set ambition at a realistic level for anyone.

The food message was focused on fibre and fat content and quality in the daily food intake. People were advised to:

• Increase whole grain bread and breakfast cereals and potatoes, vegetables and fruit in the diet
• Decrease sugar and salt intake
• Use less fat in cooking and on bread, low-fat milk instead of full fat, fish and fish products two to three times a week
• Make changes step by step: ‘It’s better that many change a little . . . ’

The Norsjö program 1987 (in agreement with the Swedish National Food Administration) decided to ‘heart-mark’ food that was low fat and/or was high in fibre. The heart label spread quickly over the country and was in 1989 renamed to ‘The green key-hole’, a national food-labelling symbol.

What health effects could be measured after 10 years? Based on the observed changes in risk factors, a 36 per cent decrease in cardiac infarction mortality could be estimated in Norsjö compared to the 1 per cent decrease in Västerbotten County as a whole. Also the decrease in cholesterol and blood pressure levels were larger in Norsjo. Changes did occur in all social groups, which was slightly more apparent among the lower educated.

The high participation rate in the Norsjö health check-ups (over 90 per cent) can be interpreted as a consequence of a recognised public-health problem, the involvement of health and medical care and the credibility that public-health work has gained in Norsjö.