Health promotion for coronary heart disease: past, present and future

Cardiovascular disease is one of the commonest causes of death and morbidity in both developed and developing countries. Health policies for the control and prevention of cardiovascular disease have traditionally relied on the control of risk factors as a major element of any strategy. Such approaches -generally termed health promotion are well illustrated by the Healthy Cities programme 1 , the British Health of the Nation strategy 2 , the Adelaide Conference and the Ottawa Charter 4 , it is always tacitly assumed that the costs of prevention will be outweighed by the costs of disease and that prevention should be promoted even in poorer countries. All these strategies make the assumption that currently available technologies are capable of modifying risk factors sufficiently to lead to reductions in disease risk.