THE “WHOLE POPULATION” APPROACH TO REDUCING CHOLESTEROL: FACTORY-BASED HEALTH EDUCATION
However, not all educational projects have succeeded like the Finnish one. The WHO (World Health Organization) European Collaborative Trial was an attempt to prevent coronary heart disease using factory-based health education. The subjects were 49,781 men aged forty to fifty-nine years, working in forty-four pairs of factories in Britain, Belgium, Italy, Spain, and Poland. The health education message was given to everyone working at the treatment factories, and not to those in the control factories.
Over all, after six years, there was an average reduction in coronary heart disease risk of 11 percent, and an average reduction of 8 percent in actual deaths from coronary disease, in the treatment factories compared to the control factories. However, the different countries varied in their success rates. The best successes were in Italy and Belgium, and in Britain there was no benefit at all, except in that by the end of the study fewer men were smoking.
The Belgian results were particularly interesting, in that the men in the treatment factories with angina and an abnormal EKG at the start of the study showed the greatest proportionate decrease in heart attacks. In the control factories, the heart attack rates in such men were 138 per 1,000 men; in the treatment factories, they were 63 per 1,000. This meant that the health education message was halving the heart attack rate in the men at highest risk—and this should be an encouragement to any reader with angina.
Why were the Belgians so different from the British? It is hardly likely that they are genetically different. Are British factory workers less likely to listen to a health message than their Belgian colleagues, or was the message not put across in a satisfactory way by the researchers in Britain? The answer is unclear, but one message from that trial was that a considerable effort is needed to make major changes in a society.
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