CINDI Highlights • Number 8 - Health Promotion Agency

CINDI Highlights • Number 8

CINDI
Countrywide Integrated Noncommunicable Diseases Intervention Programme
World Health Organization Link
An initiative of the WHO and a vital part of the WHO policy framework for supporting countries in developing health
policies, health systems and public health programmes both to improve people’s health and to reduce inequalities
in health within and between countries.
Mission
To establish cooperative projects and programmes to help prevent and control
noncommunicable diseases and to promote healthier lifestyles.
Priorities of CINDI
Reducing smoking, unhealthy nutrition, alcohol abuse, physical inactivity and psycho-social stress.
Enhancing preventive practices of health professionals.
Ensuring success by exchanging information, sharing experience and building up international networks.
Mission

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Contents
Introduction .............................................................................................. 3
Austria ....................................................................................................... 5
Belarus ...................................................................................................... 6
Bulgaria ..................................................................................................... 7
Canada ...................................................................................................... 8
Croatia ....................................................................................................... 9
Cyprus ..................................................................................................... 10
The Czech Republic ............................................................................ 11
Estonia .................................................................................................... 12
Finland .................................................................................................... 13
Germany ................................................................................................. 14
Hungary .................................................................................................. 15
Italy .......................................................................................................... 16
Kazakhstan ............................................................................................. 17
Kyrgyzstan .............................................................................................. 18
Latvia ....................................................................................................... 19
Lithuania ................................................................................................. 20
Malta ........................................................................................................ 21
The Republic of Moldova ..................................................................... 22
Poland ..................................................................................................... 23
Portugal .................................................................................................. 24
Romania .................................................................................................. 25
The Russian Federation....................................................................... 26
Slovakia ................................................................................................... 27
Slovenia .................................................................................................. 28
Spain (Catalonia) ................................................................................. 29
Turkmenistan ......................................................................................... 30
Ukraine .................................................................................................... 31
United Kingdom (Northern Ireland)................................................... 32
International Quit & Win ..................................................................... 33
CARMEN Highlights ............................................................................ 34
Notes ....................................................................................................... 36

The CINDI Programme
Noncommunicable diseases (NCDs) are a set of chronic diseases of major public
health importance, including cardiovascular disease, cancer, chronic respiratory
diseases, accidents, mental disorders and diabetes. Many of them are linked to
common preventable risk factors such as smoking, unhealthy diet, obesity and
physical inactivity, and stress. They are more prevalent in poor and disadvantaged
populations and therefore are responsible for widening the gap in life expectancy,
mortality and quality of life among and within countries in the European Region.
WHO recognises NCD prevention and control as a major health issue that needs
to be comprehensively addressed.
The WHO Countrywide Integrated Noncommunicable Diseases Intervention
(CINDI) Programme works to improve health and the quality of life in communities
by reducing premature death, disease and disability from major NCDs. Its
objectives are to enable member states:
• to develop measures for integrated disease prevention and health
promotion as part of their primary health care systems in order to
reduce morbidity by reducing common risk factors; and
• to establish effective collaborative mechanisms and methodologies to
implement these measures.
CINDI provides participating countries with an integrated approach to activities to
prevent and control risk factors and to address their social and environmental
determinants.
The concept of an integrated approach towards the prevention and control of
NCDs implies recognition that a number of risk factors are common to major
noncommunicable disease and are related to lifestyle. The implementation of the
concept combines community-based strategy directed towards a healthy lifestyle
with high risk strategy aimed at improving risk profile through preventive measures
at individual level.
At present there are 28 countries participating in the network: Austria, Belarus,
Bulgaria, Canada, Croatia, Cyprus, Czech Republic, Estonia, Finland, Germany,
Hungary, Italy, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Malta, Republic of
Moldova (became a CINDI participating country in 2002), Poland, Portugal,
Romania, Russian Federation, Slovakia, Slovenia, Spain (Catalonia), Turkmenistan,
Ukraine and the United Kingdom (Northern Ireland). Azerbaijan, Bosnia and
Introduction
Herzegovina, Georgia, the former Yugoslav republic of Macedonia, Serbia and
Montenegro are in the process of joining the network.
CINDI puts existing knowledge in participating countries to use - first in
demonstration projects in small areas and then countrywide. The programmes
implemented in demonstration areas are linked to relevant national health policies,
such as legislation on smoking or practice guidelines for preventive medicine. In
these areas, intervention measures are monitored and health trends regularly
evaluated.
Experience gained in several national demonstration projects such as the North
Karelia project in Finland or the Veliko Turnovo, Bulgaria, shows that such work
can be a powerful tool for the development of national policy.
International collaboration
CINDI Programme management
The CINDI Programme is managed by the Chronic Disease Prevention
Programme in the WHO Regional Office for Europe (www.euro.who.int), the
Council of CINDI Programme Directors, and the CINDI Programme Management
Committee.
The WHO Regional Office for Europe acts as the CINDI Programme coordinating
centre and provides the technical coordination of the core programme.
The Council of Programme Directors is the highest policy and decision-making
body for the cooperative CINDI Programme. The Council meets annually to
discuss progress achieved and outline priority action. In 2000, 2001 and 2002
the meetings took place respectively in Malta, Croatia and Cyprus.
The CINDI Programme Management Committee (which includes three country
Programme Directors, elected on rotation, representatives of the CINDI Data
Management Centre, the WHO Regional Office for Europe (WHO/EURO) and
WHO Headquarters (WHO/HQ)) assists WHO in the management and
administration of the programme. It institutes and monitors measures for quality
and control of programme data managed by the CINDI Data Management Centre,
and proposes changes to the programme protocol and manuals which should be
approved by the Council of Programme Directors.
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Introduction
Global strategy for NCD prevention and control
In 2002, CINDI continued to actively support the implementation of the WHO
global strategy for NCD prevention and control. The programme participated in the
global forum on NCD prevention and control, Shanghai, 4-6 November 2002, and
the meeting on the Mega Country Health Promotion Network, Geneva, 11-13
December 2002. The issues of the promotion of a healthy lifestyle and monitoring of
health behaviour were emphasised at the meetings.
CINDI cooperation with other WHO regional offices was strengthened: At the
annual meeting of CINDI Programme Directors, Nicosia, Cyprus, the status of
establishing NCD prevention and control networks in the WHO African and eastern
Mediterranean regions was presented. Collaboration with the Centers for Disease
Control and Prevention, USA, continued with focus on developing a system for
health behaviour monitoring in CINDI participating countries and strengthening
national capacity building on health promotion and disease prevention.
The CINDI Health Monitor
CINDI has a standardised methodology and comprehensive system for monitoring
and evaluating the programme, at both national and demonstration-area levels.
The CINDI protocol and guidelines specify the core indicators and the methods to
be used for measuring them for international collaboration. Monitoring and evaluation
are carried out at regular intervals using agreed indicators and applying an agreed
methodology for epidemiological surveys.
The CINDI Health Monitor is a survey to reflect health behaviour and lifestyle-related
risk factors to carry out at the CINDI demonstration area, regional or national level.
This activity is supported by the National Public Health Institute, Finland, and the
Centers for Disease Control and Prevention, USA. The methodology of the survey is
based on the experience of the Finbalt Health Monitor project on health behaviour
monitoring in which Finland, Estonia, Latvia and Lithuania participated.
In 1999-2002, 32 surveys were conducted in 26 CINDI-participating countries.
Data was collected by using a postal questionnaire or by a telephone or personal
interview. Information covered smoking, food habits, physical activity, alcohol intake
and personal assessment of health of people aged 25-64.
Preliminary analysis of the pilot phase of the project indicates that it is feasible to
implement such a survey across CINDI-participating countries and international
comparison of information on health behaviour is possible.
Capacity building on health promotion and disease
prevention
CINDI training course in Chronic Disease Prevention
A five-day training seminar on Evidence-Based Public Health: A CINDI Training
Course in Chronic Disease Prevention took place in Schruns, Austria, on 7-11
October 2002. This seminar was a joint effort of the WHO CINDI Programme,
Centers for Disease Control and Prevention (CDC), Atlanta, USA, St Louis
University, School of Public Health, USA, CINDI-Austria, CINDI-Finland and CINDI-
Lithuania. There were participants from 30 countries.
The course was a training seminar that provided theoretical knowledge and
improved practical skills on evidence-based NCD prevention and health promotion.
Numerous new professional contacts between participating countries have been
established. The course gave a fresh impetus, cohesion and motivation to the further
implementation and development of CINDI in participating countries. The course
stimulated the development of national or regional training materials and training
courses as well as new national or international preventative research.
Fifth CINDI Winter School
A five-day training seminar on community-based health promotion and chronic
diseases prevention was hosted by the National Public Health Institute, Finland, in
February 2002. The CINDI Winter School was the fifth training course at which
CINDI experience on the implementation of an integrated approach to NCD
prevention and control was presented. The WHO global strategy for NCD
prevention and control was introduced and practical guidance on national NCD
control programmes provided. Experience on preventative intervention in smoking,
nutrition, physical activity, high blood pressure or high level of cholesterol was
discussed. Practical CINDI programme implementation examples were presented.
A Shatchkute, MD
Regional Adviser
Chronic Diseases Prevention

Dr Günter Diem
Programme Director
In 2002 CINDI Austria activities focused on nutrition,
physical activity and education and training in the
Vorarlberg demonstration area.
Nutrition
A food programme designed for kindergartens, Maxima, was
implemented to inform children, parents and teaching staff
about the benefits of healthy nutrition. The campaign offers
information and practical examples and provides teaching material directly to
teachers and parents. ‘Gesund isst besser,’ a Healthy Austria Fund initiative to
promote better eating habits, was advertised through radio
and TV spots. ‘Top im job,’ another initiative focusing on
healthy nutrition at the workplace, was carried out by the
Association for Preventive and Social Medicine (AKS)
worksite medical centre.
Physical activity
1
X-large, a programme for overweight children, provided
guided training for children in fitness centres, combined with information about
nutrition.
Education/training
A training course in evidence-based public health was hosted in Schruns in
October. Forty students representing all the CINDI countries participated in
the week long event. This course on chronic disease prevention was a joint
effort of the WHO/CINDI programme, Centers for Disease Control and
Prevention (CDC), Atlanta, USA, St Louis University, School of Public Health,
USA, CINDI-Austria, CINDI-Finland and CINDI-Lithuania.
Smoking
‘Ich brauchs nicht - ich rauch nicht’ was a nationwide advertising campaign to
reduce smoking among young people aged 10 to16. The initiative was
launched by the Healthy Austria Fund and was supported locally by AKS.
Austria
Mental health
Demenz 2000, a screening and early intervention programme for dementia in
the 65+ age group, was completed and a final report has now been published.
Further activities
In addition to the general cancer registry, a colon cancer registry was
established focusing on a recall system for patients with different risks. The
registry is also managed by AKS.
Further information
The CINDI Programme in Austria/Vorarlberg is managed by the AKS. For
more information, please contact the CINDI Programme Director, Dr Günter
Diem, Medical Director AKS, Rheinstrasse 61, A-6900 Bregenz, Austria. Tel:
+43 5574 64570 1039; Fax: +43 5574 64570 61039; Mob: +43 66418
55011; E-mail: guenter.diem@aks.or.at
1. The Maxima food programme logo
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Belarus
Dr Alexander Grakovich
Programme Director
In 2002 the CINDI Programme in Belarus focused
on the formation of a coalition involving the
leaders of the health administrative bodies in
various regions. The work was aimed at regular
activities in the prevention of noncommunicable
diseases.
Primary health care
The national programme ‘Development of primary health
care’ was progressed and, in December 2002, was approved by the
government. Work involving the majority of specialists from the Ministry of
Health continued, with emphasis initially on general practitioners and sector
therapists from polyclinics in order to control the prevalence of major risk
factors of noncommunicable diseases.
Close contacts were established with the city of Minsk health committee
leaders who were satisfied with the Belarus Centre for Medical Technologies
results in the area of primary prevention of noncommunicable diseases. The
results were based on studies at polyclinic No 36 in Minsk. It was decided to
set up additional centres in each of the eight districts of Minsk. The formation
of similar centres in each regional city of Belarus is under discussion.
The CINDI Health Monitor survey, which included four demonstration zones,
was implemented with a total of 3,174 people involved. The social study
aimed at monitoring the implementation of the National Programme on Healthy
Life was conducted in all regions of Belarus with a total of 1,100 respondents
covered.
Effective actions were undertaken by the CINDI Programme team in the
preparation of guidelines and methodical materials for general practitioners.
Four training seminars for physicians in the republic were also conducted.
Hypertension management
The implementation of the Ministry of Health order on the management of
hypertension permitted the involvement of physician-therapists in activities
controlling the major risk factors of cardiovascular and other
noncommunicable diseases. The emphasis was placed on nutrition correction,
increase of physical activity, quitting smoking and its prevention. Work was
also undertaken with groups of hypertension patients.
Smoking
The Quit & Win smoking cessation campaign was conducted in Belarus for
the fourth time. An estimated record number of 9,000 people took part.
Smoking prevention and restriction activities were actively carried out among
adolescents and young people at health centres.
Nutrition
The majority of Ministry of Health specialists were involved in nutrition
correction work to help decrease the risk of the development of
noncommunicable diseases. Such examples of work with Belarussian
citizens included the ‘School of healthy diet’ and ‘School of diabetes’ which
were carried out through polyclinics and health centres.
Further information
The CINDI Programme in Belarus is managed by a Coordinating Council on
Control and Development of the Programme. For further information, please
contact CINDI Programme Director, Dr Alexander Grakovich, Director of the
Belarus Centre for Medical Technologies, Computer Systems, Administration
and Management of Health, 7-a P. Brovki Str, 220600 Minsk, Republic of
Belarus. Tel: +375 172 32 3080; Fax: +375 172 32 3080; E-mail:
belcmt@belcmt.belpak.minsk.by

Dr Nikola Vassilevsky
Programme Director
CINDI Bulgaria Programme activities developed the
key policy and strategy areas during 2002.
Health monitor survey
The CINDI Health Monitor survey was conducted in six
CINDI demonstration areas. Nine thousand men and
women aged 25-64 were included, samples were
representative to the general population of each area. Apart
from a survey of the major behavioural risk factors, blood
pressure, height and weight were measured according to
the procedures of the WHO MONICA project, waist and hip circumference, as
well as a complete lipid profile blood test were also carried out.
Hypertension management control
Hypertension was prevalent in all CINDI demonstation areas. A team
comprising members from the CINDI area of Veliko Turnovo and the Regional
Health Insurance Fund assessed hypertension pharmaceutical treatments for
their scope and quality. General practitioners prescribed treatment to an
estimated 10,000 patients diagnosed as hypertensive was compliant with
WHO recommendations. However, only 50% of these hypertensives were
actually treated and monitered. A similar study was launched in four further
areas, accounting for an estimated 5,000 hypertensives. Health professionals
in these areas were trained in hypertension control issues.
Public health education
The development of health knowledge and skills within the population for the
promotion of a healthy lifestyle and the control of risk factors continued with
focus on smoking, low physical activity and unhealthy diet. In excess of 500
radio and 250 TV broadcasts were aired and more than 200 materials on
health risk factors were published. Health education campaigns on
hypertension management, cerebrovascular disease, coronary heart disease,
breast cancer, osteoporosis, diabetes, etc were carried out. More than 20
different health education resource materials were disseminated.
Bulgaria
Local health policy development
Development of tobacco, nutrition and physical activity policies in the CINDI
areas continued.
Further information
In Bulgaria the Ministry of Health is responsible for the CINDI Programme
which is coordinated by the National Centre of Public Health. For more
information, please contact the CINDI Executive Director, Dr Nikola
Vassilevsky, Department of Health Promotion and Disease Prevention, National
Centre for Public Health, 15 D Nestorov Str, 1431 Sofia, Bulgaria. Tel: +359
2 958 1515; Fax: +359 2 591 146; E-mail: nicvass@otel.net
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Canada
Dr Sylvie Stachenko
Programme Director
CINDI Programme activities in Canada during 2002
included the establishment of the Chronic Disease
Prevention Alliance and contribution to policy
development of a countrywide healthy living
strategy.
National/provincial
The CINDI Programme functions at national and
demonstration area levels. The purpose of CINDI
Canada is to build capacity for noncommunicable
disease prevention at national, provincial and community
levels. The backbone of CINDI Canada has been the Canadian Heart Health
initiative, but is moving towards an integrated approach to major chronic
disease prevention.
A national Chronic Disease Prevention Alliance has been established,
including 12 nongovernmental organisations in collaboration with Health
Canada, to develop an integrated strategy for chronic disease prevention.
CINDI Canada has provided significant input to the establishment of a
pan-Canadian collaborative strategy on healthy living. The healthy living
strategy will focus on healthy nutrition, physical activity and healthy weight in
order to reduce the burden of major chronic diseases.
Chronic disease prevention
Specific components of the breast cancer initiative and of the diabetes
strategy are in the process of developing disease surveillance and programme
tracking systems. The diabetes strategy has developed a national marketing
campaign to raise awareness of diabetes among Canadians. The Canadian
Strategy for Cancer Control has also been launched
(www.cancercontrol.org).
A recent study was carried out to assess the feasibility of integrating heart
health and diabetes prevention activities and to move towards a more
integrated approach to chronic disease prevention. The Canadian Heart
Health initiative has completed the dissemination phase. Eight provinces have
received funding to study factors and processes that mediate the uptake of
successful interventions by government jurisdictions, organisations and
communities and to gain knowledge on how to configure delivery
organisations to promote widescale implementation of effective prevention
activities.
International
The G8 Promoting Heart Health telematics project allows access, through the
Internet, to practical knowledge and experience on the implementation of heart
health interventions among selected G8 countries (www.med.mun.ca/chhdbc).
Policy analysis study
CINDI Canada has prepared a comparative analysis of policy development
and implementation of processes in CINDI countries. A preliminary report has
been completed and further analysis is being carried out. Essential to the
further analysis of the information was the establishment of a computerised
database which is now housed at the WHO Regional Office for Europe.
Further information
The CINDI Programme in Canada is managed by Health Canada, in the
Centre for Chronic Disease Prevention and Control, WHO Collaborating
Centre for Policy Development in the Prevention of Noncommunicable
Diseases. For more information, please contact Dr Sylvie Stachenko, Director,
WHO Collaborating Centre on Noncommunicable Disease Policy, Centre for
Chronic Disease Prevention and Control, Population and Public Health
Branch, Health Canada, Room l543B, (PL 1915B) Jeanne Mance Building,
Tunney’s Pasture, Ottawa, Ontario K1A 1B4. Tel: +613 954 8629; Fax: +613
952 4196; E-mail: sylvie_stachenko@hc-sc.gc.ca

Professor Zeljko
Metelko
Programme Director
This year’s CINDI Programme work in Croatia included
activities on education, physical activity, intervention
campaigns and data collection.
Education
In 2002 the education of schoolchildren focused on the
prevention of smoking and drug abuse through informing
young people about all the possible conseqences for health.
The education programme for primary health care physicians
and medical specialists covering the problem of
noncommunicable disease and diabetes was further developed. Education of
nurses and pharmacists in the approach to diabetic patients and patients with
noncommunicable diseases was also organised.
Physical activity
Different activities were organised during the year in both primary schools and
secondary schools with the aim of increasing the amount of physical activity
undertaken in the younger population.
Intervention campaigns
Programmes and activities implemented as part of the antismoking campaign
and emphasising the role of the community in heart disease prevention and
health promotion were further developed.
Data collection
The register on myocardial infarction was maintained. A new software
package for following up patients with diabetes and which enables
communication between all diabetes centres in the country, The CroDiabNET
Croatian Diabetes Register, was further developed. The basic information
sheet contains all the data collected during regular checkups over a one year
period. Up to the end of 2002, data from 28,045 patients from 19 centres in
Croatia have been collected.
Croatia
Further information
The CINDI Programme in Croatia is managed by representatives from the
University Clinic for Diabetes, Endocrinology and Metabolic Disease, the
Institute for the Prevention of Cardiovascular Disease, and the School of
Public Health. The programme is supported by the Ministry of Health. For
more information, please contact the CINDI Programme Director, Professor
Zeljko Metelko, Director, Vuk Vrhovac University Clinic, Dugi dol 4a, 10000
Zagreb, Croatia. Tel: +385 1 233 1480; Fax: +385 1 233 1515; E-mail:
zeljko.metelko@zg.tel.hr
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1. CINDI annual meeting, Dubrovnik 2001.
2. CINDI group at Vuk Vrhovac University Clinic
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Cyprus
Dr Charitini Komodiki
Programme Director
Smoking, obesity, physical inactivity and unhealthy
nutrition continued to be the main focus of the
Cyprus CINDI Programme activities. This year’s
highlights included work undertaken for risk
reduction among schoolchildren.
Demonstration area
The demonstration area of the District of Nicosia has a
population of 273,129. The CINDI Programme
intervention activities are implemented throughout the whole island.
Healthy children programme
Special emphasis is set on the monitoring and reduction of risk factors among
schoolchildren in primary schools. The healthy children programme, which was
initiated in 1997, is a preventive medical programme directed at all
schoolchildren in the sixth grade. The programme includes the clinical
examination of pupils, collection of data on dietary habits and analysis and
presentation of data to parents. The medical tests of 50,000 pupils
highlighted the poor eating and unhealthy lifestyle of Cypriot students. Forty
five per cent of the evaluated pupils showed cholesterol levels above the
upper limit for their age.
Within the programme framework the following programmes/studies have
been conducted to examine: (a) the prevalence of obesity in children and
adolescents in Cyprus; (b) possible associated environmental factors; (c) the
construction of percentile curves for certain anthropometric variables and
indices such as weight, height, Body Mass Index (BMI) and skin fold
thickness; (d) blood lipids, glucose, the physical activity level, weight, height
and triceps skin fold in schoolchildren aged 10-17 years who cycle compared
to a control group; (e) planning and implementation of education programme
improvement in schools.
Smoking
In Cyprus, 38.5% of men and 7.5% of females are smokers. The antismoking
campaign includes public information, smoking cessation programmes, school
competitions, press conferences, athletic games etc. All activities are
intensified during Non Smoking Day and the Quit & Win smoking cessation
competition.
Risk factor survey results
The results of the second national risk factor survey carried out in 2000 are
not satisfactory - 22.6% of Cypriots are hypertensive (BP>140/90mm HG),
54.9% have high cholesterol levels and 35.8% are overweight.
Further information
The CINDI Programme in Cyprus is managed and coordinated by the Ministry
of Health, and is supported by various scientific associations and
nongovernmental organisations. For more information, please contact the
CINDI Programme Director, Dr Charitini Komodiki, Chief Health Officer,
Ministry of Health, Markou Drakou 10, 1448 Nicosia, Cyprus. Tel: +357 2 309
511; Fax: +357 2 305 803; E-mail: ministryofhealth@cytanet.com.cy
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1. Some of the participants in the healthy children programme
2. The child health website

Professor Lumír Komarek
Programme Director
This year’s CINDI Programme work included
activities on smoking, alcohol, the management of
National Health Programme projects, the prevention
of cancer and the CINDI Health Monitor survey.
National Health Programme (NHP)
The CINDI centre coordinates NHP projects and in 2002
a total of 110 projects were implemented. Of these, 10
focused on healthier nutrition, six on smoking, eight on
coping with stress and eight on physical activity. Ten projects involved the
prevention of cardiovascular disease, 15 related to cancer and seven covered
accidents and intoxication. Fourteen projects were devoted to Health
Promoting Schools.
Smoking
A Quit & Win smoking cessation competition was organised. In conjunction
with World No Smoking Day a climb of the highest mountain in the Czech
Republic, Mt Snezka, was organised with the participation of distinguished
physicians and politicians. The bulletin Tobacco and health is published four
times per year.
Alcohol
Three courses were held - Alcohol and Family, Alcohol and Women, Alcohol
and Transport. A publication Alcohol and accidents and the Czech version of
a publication by B Ritson, Community and municipal action on alcohol, were
published.
Cancer disease prevention
The cancer disease prevention project, undertaken by the CINDI centre and
district interdisciplinary intervention teams in 30 districts under the
guidance of CINDI, was continued for the third year. The project focused in
particular on the education of general practitioners and specialists in primary
and secondary prevention.
The following publications were produced: Health promotion and cancer
prevention in health policy and Handbook of prevention and early detection
of cancer. Two popular scientific films, Gates of Life and Against Ourselves,
Czech Republic
were prepared and were awarded the main prizes in their categories at the
Crystal Heart film festival.
CINDI Health Monitor
Collection of data proceeded in May. Simple random sampling procedure was
used to select the study population. A face-to-face interview was used to collect
data. A total of 3,040 persons in the age group 25-64 participated in the survey.
Further information
The CINDI Programme in the Czech Republic is managed by the National
Institute of Public Health, Centre of Health Promotion and Disease Prevention.
For more information, please contact the CINDI Programme Director,
Associate Professor Lumír Komarek, MD, Centre for Health Promotion and
Disease Prevention, National Institute of Public Health, Srobárova 48, 100 42
Prague 10, Czech Republic. Tel/fax: +420 2 673 102 91;
Email: komarek@szu.cz
Or
The CINDI Programme Vice-Director, Jarmila Rázová, MD,
Dept. of Hygiene and Epidemiology, Ministry of Health, Palackého nám. 4, 128
01 Prague 2, Czech Republic. Tel: +420 2 249 721 89, Fax: +420 2 249
160 07, E-mail: jarmila.razova@mzcr.cz
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1. Doctors and politicians climb on World No Tobacco Day
2. Focus on healthy nutrition
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Estonia
Associate Professor
Margus Viigimaa
Programme Director
This year’s CINDI highlights included work on risk
factors surveys, a CINDI/EuroPharm Forum joint
project, a national cardiovascular disease (CVD)
prevention programme and noncommunicable
disease (NCD) risk factors in schoolchildren.
Risk factors survey
A new risk factors survey started in 2002 involving men
and women aged 65 to 74 residing in the CINDI
demonstration area of Tallinn. The aspects of ageing in
NCD epidemiology were investigated. The Estonian
Institute of Cardiology carried out the survey in accordance with CINDI
methodology. Additional anthropological, biochemical and instrumental
investigations were also used in the study to collect data on the health status
of the study population.
A joint CINDI/EuroPharm Forum project
The pharmacy-based hypertension management project was extended to
seven pharmacies in Estonia (five in Tallinn, and one in both Tartu and
Haapsalu). For eight months, level 1 (primary prevention) services were given
to 14,064 pharmacy clients, level 2 (detection of hypertension) services to
2,184 clients and level 3 (hypertension management) services to 550 clients.
In patients monitored at the pharmacies, the systolic blood pressure mean
values decreased by 9 mmHg and diastolic blood pressure mean values
decreased by 5.8 mmHg (the last three values versus the first value).
CVD prevention programme
The national CVD prevention programme for 2002-2006 was started
successfully. Teams of two national prevention centres in Tartu and in Tallinn,
14 regional heart health units and 100 family physicians have screened and
advised more than 12,000 subjects aged 30-60 years for cardiovascular risk
factors.
NCD risk factors in schoolchildren
The CINDI children programme in collaboration with the national programme
‘Children’s and adolescents health until 2005’ has resulted in intervention at
population level. The monitoring of NCD risk factors has been implemented as
routine in the school health service. The distribution of Guidelines on
detection of NCD risk factors in schoolchildren among family physicians in
Estonia was continued.
Further information
The CINDI Programme in Estonia is managed by the Department of Public
Health of the Estonian Ministry of Social Affairs, the Estonian Centre of Health
Education and Promotion, the University of Tartu and the Estonian Institute of
Cardiology. For more information, please contact the CINDI Programme
Director, Associate Professor Margus Viigimaa, Department of Cardiology,
Tartu University Hospital, Puusepa St 8, Tartu EE-51014, Estonia. Tel/fax:
+372 7 318 467; Mob: +372 5 110 070; E-mail: Margus.Viigimaa@kliinikum.ee

Professor Aulikki Nissinen
Programme Director
The main CINDI Programme activities in Finland
during 2002 included the seventh national
population risk factor study, World Health Day
activity and international collaboration.
National FINRISK study
The seventh national population risk factor study mapping
the risk factors of the most important NCD in Finland was
carried out in spring 2002. The aim is to establish the risk
factor levels, especially for cardiovascular diseases,
diabetes and cancer. In total over 9,000 Finnish
participants were included from 131 communities within six provinces.
Quit & Win
The National Public Health Institute (KTL) has coordinated the International
Quit & Win smoking cessation competition every second year since 1994.
The latest Quit & Win in May 2002 attracted some 660,000 smokers in 77
countries worldwide. In Finland the 2002 campaign was organised by the
Finnish Health Association and an estimated 6,900 smokers, including 740
health professionals, participated.
International collaboration
During 2002 CINDI Finland was involved in substantial international work.
Close collaboration took place with Bosnia and Herzegovina, an applicant for
the CINDI network, to improve the capacity of the Federal Public Health
Institute and to build up a risk factor and disease monitoring system. There
was close collaboration also with the CINDI demonstration area Pitkäranta in
the Republic of Karelia, Russia. The third population risk factor survey was
carried out in Pitkäranta in spring 2002. Also, several other health promotion
activities such as the Pitkäranta Health Day were organised.
Finland
Activities in the Finnish CINDI demonstration area,
North Karelia
World Health Day
The main event of World Health Day (WHD) in Finland was organised during
April in Joensuu, North Karelia. The event received wide publicity and was also
the start of a provincial physical activity campaign in North Karelia. The WHD
event and the 30th anniversary of the North Karelia project were both hosted
by the President of Finland Mrs Tarja Halonen.
Karelian medical conference
The seventh Karelian medical conference was organised in Joensuu in
September and attracted over 100 participants from Finland and The Russian
Federation. The conference focused on the health situation, health promotion
and disease prevention aspects as well as the collaborative health activities
between Finland and the Republic of Karelia.
Further information
The CINDI Programme in Finland is managed by KTL. For more information,
please contact the CINDI Director, Professor Aulikki Nissinen, Department of
Epidemiology and Health Promotion, National Public Health Institute,
Mannerheimintie 166, FIN-00300, Helsinki, Finland. Tel: +358 9 4744 8336;
Fax: +358 9 4744 8338; E-mail: aulikki.nissinen@ktl.fi
1
1. National FINRISK study 2002
13

14
Germany
Professor Egbert Nüssel
Programme Director
This year’s activities included the development of
collaboration between pharmacists and general
practitioners on the primary prevention of
noncommunicable diseases (NCD). Evaluation of
risk factor intervention in general practices was
also undertaken.
The CINDI demonstration areas in Germany are Kreis
Bergstrasse (with approximately 260,000 inhabitants) and
Heidelberg (approximately 140,000 inhabitants).
Primary prevention of NCD
Under the umbrella of the joint CINDI/EuroPharm Forum project on
hypertension management at pharmacies, a pilot project to enhance
collaboration between general practitioners and pharmacists on the primary
prevention of NCD was launched in the CINDI demonstration areas in 2001.
The experience gained through the pilot study involving 16 pharmacies in
CINDI Baden-Württemberg was positive. The results relate to 500 persons
who visited the pharmacies for measurement of cholesterol or blood pressure
levels. The results show that the pattern of cholesterol levels recorded by the
pharmacists was very similar to that of the cholesterol levels recorded for
patients visiting general practitioners.
Participants were requested to complete a standardised health questionnaire
and were advised to consult their GPs if the levels were too high. Advice on
lifestyle modification relating to personal risk factor profile was given. Based
on this experience, in 2002 information about the project was disseminated to
all pharmacies in the CINDI demonstration areas as well as in the south of
Hessen and the north of Baden-Württemberg (500 pharmacies). Many of
those approached have shown an interest in participating.
In parallel to a new pilot study in the CINDI demonstration areas, it is intended
to run a larger study which would include interested pharmacies in areas
outside the CINDI demonstration areas (the north of Hessen and the north of
Baden-Württemberg).
Evaluation of risk factor intervention
In the north of Bavaria, the north of Baden-Württemberg and the south of
Hessen 34 general practices have been participating since 1990 in a project
aimed at the reduction of risk factors for NCD through intervention measures
in general practice. In 2002 a project was launched to evaluate the impact of
this intervention. A neutral team was appointed for this purpose.
The team visited each of the general practitioners involved and random
samples of their patients were drawn. Within a retrospectively established
cohort of 100 men and 100 women, the most recent findings relating to
smoking habits, body mass index, blood pressure and cholesterol were
compared with those documented at least six months previously. It was at the
same time possible to ascertain the rate of the missing information relating to
the risk factors.
The first results from 10 general practices (1,000 men and 1,000 women)
were to be made public by the Mayor of Heidelberg by the end of March
2003. It is expected that a comparison of the results will encourage dialogue
and lead to concrete intervention measures.
Preparatory work was started in 2002 for the same project to be carried out
in the rural demonstration area of Kreis Bergstrasse.
Further information
For more information, please contact Professor Egbert Nüssel, CINDI
Programme Director, Wissenschaftliches Institut der Praxisärzte, Villa Bosch,
Schlosswolfsbrünnenweg 33, 69118 Heidelberg, Germany. Tel: +49 6221
533 119; Fax: +49 6221 533 177; E-mail: egbert.nuessel@wip.villa-bosch.de

Professor Endre Morava
Programme Director
This year’s CINDI highlights included the health
behaviour survey in the demonstration area (Pécs
city) and, at national level, antismoking activities
and health promotion among secondary school
students.
Health behaviour survey
The CINDI Health Monitor survey started during the
previous year was completed. The questionnaire was
mailed to 6,000 adults representing the sex, age and
settlement distribution of the Hungarian population
nationally, with a subsample representing Pécs city. The response rate was
54%, the highest rate experienced in Hungary recently. The results were
compared with a recent survey carried out by direct interview and, for similar
questions, very similar distributions of answers were received. The results
indicate that the CINDI health behaviour survey carried out by postal enquiry
will be a useful and relatively inexpensive tool to monitor the lifestyle and
health status of the Hungarian population.
Quit & Win programme
CINDI organised the Quit & Win smoking cessation competition in Hungary
five times during the year. Over 4,200 adults and 358 14-17 year olds
participated. Special attention was paid to ensure more involvement from
health professionals who are smokers and helping them to quit; 986 doctors
and nurses were successfully enrolled as participants in the programme.
Peer education programmes
The main aim is for future generations of doctors to serve as positive
examples of healthy behaviour. A peer education programme was organised
for medical students to become health education trainers who could provide
information on drug abuse, alcohol abuse, smoking and safe sex (AIDS
prevention). Nineteen new peer educators were trained during the year. There
was also participation in the international Tobacco Prevention Initiative through
the Medical Student Survey with 490 medical and dental students being
surveyed at the end of their pre-clinical study.
Through the peer education system secondary schools all over Hungary were
offered the services of trainers. In 21 secondary schools six hour-long
anti-drug programmes were delivered, in 15 cities anti-smoking programmes
Hungary
and in nine cities anti-alcohol programmes were organised. Safe sex and
HIV/AIDS prevention programmes were organised in 19 cities.
Further information
The CINDI Programme in Hungary is managed by the Department of Public
Health at the Medical Faculty of Semmelweis University, Budapest. For more
information, please contact the CINDI Programme Director, Professor Endre
Morava MD, Department of Public Health, Medical Faculty, Semmelweis
University, PO Box 370, 1445 Budapest, Hungary. Tel/fax: +36 1 210 2954;
E-mail: morend@net.sote.hu
15

16
Italy
Professor Maria
Teresa Tenconi
Programme Director
This year’s CINDI highlights included activities on
smoking, cardiovascular disease prevention and
the health monitor survey.
Smoking
In the Lombardy region, a special project for smoking
prevention among young people has been planned. It is
financed with a fund of ¤309,877. A pilot project lasting
three years and targeting an estimated 15,000 students
is being implemented in the province of Pavia, the
success of which will be evaluated on a yearly basis.
The project consists of different programmes, one for
each school grade from kindergarten through to secondary school. It was
launched during 2002 in kindergarten schools (7,300 children) with the aim of
helping pupils learn through the use of special plays and games, and how to
appreciate a clean and smoke-free environment. All the programmes require
special training for teachers and the involvement of the young students’
families.
The same region organised a survey of 5,348 general practitioners, covering
opinions and attitudes about smoking prevention and counselling. In 2002,
also in Lombardy, the number of smoking cessation centres staffed by
specialised health personnel rose to 45.
Cardiovascular diseases
A new population study based on the selection of a population sample by
family name started in Brisighella. The project aim is to carry out specific
genetic analyses about atherosclerosis.
The evaluation of physical activity and related cardiovascular risk under the
Perseus Project in the Latina area was completed.
The VIP project (Valle dell’Irno), aimed at cardiovascular risk evaluation, is
being undertaken through the recruitment of members of the youngest
section of the population (240 participants) from 15 to 24 years of age. The
participation in World Heart Day in September was used to give the
population more advice on healthy lifestyle.
Health Monitor survey
All the Italian CINDI areas planned and completed the CINDI Health Monitor
survey covering an estimated 3,000 participants.
Further information
The CINDI Programme in Italy is a network of local and regional projects
coordinated by the Department of Preventive, Occupational and Community
Medicine, Faculty of the University of Pavia. For more information, please
contact the CINDI Programme Director, Professor Maria Teresa Tenconi,
Hygiene Section, Department of Preventive Medicine, University of Pavia, Viale
Forlanini 2, 27100 Pavia, Italy. Tel: +39 38 250 7278; Fax: +39 38 250
7558; E-mail: tenconi@unipv.it

Professor Aikan Akanov
Programme Director
The year’s CINDI highlights included activities
focused on health promotion and prevention of
noncommunicable disease risk factors such as
tobacco smoking, alcohol abuse and being
overweight.
National level
In Kazakhstan 2002 was declared Year of Health. The
main priorities of the year’s programme included
improving the population’s health, developing health
care and promoting healthy lifestyles.
An epidemiological study of four million rural inhabitants was carried out,
which included screening, surveying and medical evaluation with the next
stage being the development of health and fitness observation and monitoring.
A study of 1.7 million children was also carried out consisting of programme
development, medical evaluation, treatment and fitness improvement. The first
positive result of this study was the significant improvement in health of
approximately 21% of children. Data from both studies now form a common
database.
The National Centre for Problems of Healthy Lifestyle Development was one
of the key bodies for developing the law on the prevention and restriction of
smoking, which was passed by the government in July.
Risk factor and NCD prevention programmes were started at primary level
and included health education, provision of information to the public and staff
training and research. A practical WHO/CINDI seminar ‘From research to
practice’ was held in Almaty in August with participation by representatives of
the Ministry of Health, 13 regional health departments, the National Scientific
Research Institute of Cardiology, and the National Centre for Problems of
Healthy Lifestyle Development.
In 2002 prevention methods were included on the curricula for postgraduate
courses at the ‘Disease prevention and health promotion’ Department of
Almaty State Institute for postgraduates and the National Centre. Primary
health care physicians are also receiving training.
Kazakhstan
Intervention campaigns
21,000 participants took part in the Quit & Win smoking cessation campaign,
which was organised by the CINDI Kazakhstan group and the National Centre
for Problems of Healthy Lifestyle Development.
Demonstration areas
Several epidemiological research studies were carried out in the four
demonstration regions with prevention programmes being developed and
implemented. A health survey of 3,777 adults aged 15-64 years was also
carried out and was based on the WHO CINDI Health Monitor questionnaire.
The annual meeting entitled ‘The implementation of the CINDI programme in
Kazakhstan’ took place in December with financial support from WHO
Regional Office for Europe.
Further information
The CINDI Programme in Kazakhstan is managed by the National Centre for
Problems of Healthy Lifestyle Development of the Ministry of Health and its
services in 15 different regions of Kazakhstan. It is coordinated by the
research department’s division of medico-social and prevention programmes.
For more information, please contact the CINDI Programme Director,
Professor Aikan Akanov, Director General of the National Centre for Problems
of Healthy Lifestyle Development, 86 Kunaev Str, Almaty, Kazakhstan.
Tel: +7 3272 9120 81; Fax: +7 3272 9188 42; E-mail: akanov@mailbox.kz
17

18
Kyrgyzstan
Professor Tilek
Meimanaliev
National Director
Dr Chinara
Bekbasarova
Deputy Director
This year’s highlights included the
CINDI national health behaviour
survey for adults aged 18 and over.
The random sample comprised a
total of 8,000 people with a
response rate of 96.7% (7,737 total
comprising 3,527 men and 4,210
women) including 5,838 people
(2,663 men and 3,175 women) aged
25-64 years. The database of the survey for respondents aged 25-64
years is being analysed separately.
Health services and health status:
The survey findings showed that:
• 40.5% of the adult population (32.7% men and 47.2% women) had
their blood pressure measured by a doctor during the previous year,
18.7% between one and five years ago, 8.7% more than five years ago;
16% of people had never had blood pressure measured, and 16% of
respondents did not know when their blood pressure was last
measured;
• 37.2% (41.2% rural and 31.7% urban) of respondents listed their
present health status as good, 11.9% as reasonably good, 41.9% as
average, 2.8.% as rather poor and 2.2% as poor;
• 84.6% of the population seek medical attention only when they are very
sick, 8.1% when they feel mild pain; only 2.1% of the population are
regularly checked by doctors and 5% of the respondents did not specify.
Smoking
At present, 62.5% of the adult population aged 18 and older smoke on a daily
basis, 64% of men and 41.4% of women are regular smokers, 10.5% of
people use nasvay chewing tobacco or snuff daily (11% of men and 4.4% of
women), and only 14.9% are non-smokers (13.2% men and 38.2% women);
69% of those interviewed feel that direct or indirect advertising of tobacco
and tobacco products should be banned in Kyrgyzstan. Only 7% of
respondents said it should not be banned and 24% were undecided; 72%
believe that the government should sign the Tobacco Control Convention
Framework in May 2003 and only 3% do not want it to be signed.
Nutrition
According to the national survey, 85% of the population have breakfast every
morning, 57% (32% of men and 78% of women) cook food at home every
day, with 10% cooking two to three times a week; 3% cook once a week,
5.6% two to three times a month, 9.1% a few times a year and 11% never
cook at home. Most of the population (81%) use vegetable oil for cooking
food, only 0.5% use margarine, 7.6% mixed fat and 1.1% animal fat, while
0.1% of the population do not use fat at all for cooking.
Alcohol
During the past year, 54% (66.3% of men and 43.6% of women) consumed
alcoholic drinks; 0.3% (0.6% men and 0.1% women) drink strong spirits on a
daily basis, 2.6% (4.7% men and 0.8% women) drink two to three times a
week, 4.4% (7.8% men and 1.6% women) drink once a week, 13.7% (20.3%
men and 8.2% women) drink two to three times a month, and 30.8% (31.8%
men and 29.9% women) drink a few times a year; 47.4% (33.8% men and
58.8% women) do not drink strong spirits.
Further information
The CINDI Programme in Kyrgyzstan is managed by the Ministry of Health. For
more information, please contact the National Director, Professor Tilek
Meimanaliev, or Dr Chinara Bekbasarova, Deputy Director, Ministry of Health
of Kyrgyz Republic, Moscowskaya, Str. 148, 720405 Bishkek, Kyrgyzstan.
Tel: +996 312 22 86 97; Fax: +996 312 66 04 93; E-mail: cindi@elcat.kg
1
`1. 'Quit & Win' winners and volunteers with Dr Ludmila
Shteinke, Deputy Minister of Health, Mrs Cajira Karataeva,
medical workers Trade Union representative and Dr Chinara
Bekbasarova

Dr Vilnis Dzerve
Programme Director
This year’s highlights included work on nutrition,
hypertension, diabetes and the health behaviour
survey. Some of the activities and interventions took
place at a national level while others concentrated
on the CINDI demonstration area.
Health behaviour survey
The CINDI Latvia office together with the state health
promotion centre conducted the third health behaviour
survey between April and July. The sample size of 3,000 people ranged in age
from 25 to 64, with a response rate of 67.3%.
Nutrition
The Healthy Nutrition Action Plan 2002 - 2007 was developed after analysis
of current practice in ensuring safe and healthy food and the avoidance of
food related diseases. In order to define the 11 main targets, current practice,
factors delaying development and desirable results were analysed.
Public opinion surveys on nutrition show that both economic factors and lack
of information on safe and healthy nutrition obstruct consumers choice of safe
and healthy food, because:
• more than 60% of the population admit that price is the determining
factor in their choice of food;
• less than 33% of the population know that different fats in food pose
different health risks;
• 67% of respondents know that excessive use of salt in food may be
harmful to health.
Hypertension management
A hypertension management survey was conducted in March and April.
Analysis of drug intake demonstrates a low rate of regular pharmaceutical
treatment in Riga and in Latvia as a whole. According to physicians, the
estimated average rate of one year compliance with pharmacological
treatment is 49.2% (48.7% in urban areas and 49.7% in rural areas).
Physicians announced 35.9% of their patients (37.5% in city and 33.9% in
village) maintained a target blood pressure (BP) for at least six months.
Latvia
The proportion of patients on medication who had a target BP

20
Lithuania
Professor Vilius Grabauskas
Programme Director
Out of numerous CINDI activities, the year’s
highlights focused on work in the areas of
smoking, mental health and health promotion
activities.
Smoking
The 2001 survey revealed that almost 50% of boys
and 25% of girls aged 12-18 were regular smokers.
High priority was therefore given to tobacco control actions aimed at
adolescents and young people.
An antismoking campaign ‘Don’t start and win - quit and win’ aimed at
schoolchildren was launched in Kaunas. Around 2,300 schoolchildren
registered to take part. Smokers had to abstain from smoking and nonsmokers
had to commit to not starting for at least a month. More than 50
winners were awarded with a trip to the Water Game Park in Poland.
To emphasise the problem of passive smoking, the campaign ‘I was born a
non-smoker’ was organised on No Smoking Day (31 May), with all newborns
in Kaunas being presented with campaign shirts.
Another campaign, ‘Let me grow up healthy’, saw hundreds of children’s
shoes laid down on the pavement near the Lithuanian Parliament symbolising
their risk of passive smoking. An appeal requesting members of Parliament to
develop a stricter tobacco control policy was handed in.
Mental health
A study aimed at assessing the prevalence of mood disorders and depression
was carried out in a CINDI demonstration area (Kaisiadorys). Standard
questionnaires were filled in by 235 patients who visited primary health care
centres in Kaisiadorys and surrounding rural areas. Mood disorders were
diagnosed in 48.4% of men and 61.9% of women. Results showed the
prevalence of mood disorders was increasing with age. Depression was
diagnosed in 27.6% of men and 31.8% of women. High prevalence of mood
disorders and depression detected through primary care structures led to an
initiative by the CINDI team to start a comprehensive community based
mental health programme.
Health professionals and lifestyles
In Lithuania, health professionals are key players in the delivery of
noncommunicable disease (NCD) prevention through primary health care. The
role of health professionals in health promotion activities was assessed using
data from the Lithuanian health behaviour monitoring survey conducted in
2000. The respondents were asked whether they had been advised to change
their smoking, nutrition, alcohol consumption and physical activity habits by
health professionals.
However, only 13% of smokers were advised by doctors to stop smoking.
One in 10 men and one in five women received recommendations for
changing dietary habits. Health professionals were even less active in advising
to reduce alcohol consumption and to increase physical activity. To improve
motivation and involvement in health promotion activities, a special course on
NCD prevention and health promotion was developed and introduced as part
of a continuing education programme for general practitioners.
Further information
Kaunas University of Medicine manages the CINDI Programme in Lithuania in
collaboration with the Ministry of Health. For more information, please contact
the CINDI Programme Director, Professor Vilius Grabauskas, Chancellor,
Kaunas University of Medicine, Mickevitchiaus 9, Kaunas 3000, Lithuania.
Tel: +370 37 32 72 02/03; Fax: +370 37 22 07 33; E-mail: vilgra@kmu.lt
1
1. Lithuanian winner of ‘Quit & Win’ with Dr Veryga and Professor
Puska, Warsaw 2002

Ms Maria Ellul
Programme Director
The year’s highlights included initiatives on tobacco
control, sexual health promotion, cancer prevention
and a survey on health behaviour in school aged
children.
Cancer prevention code
Malta launched its 10 point code aimed at preventing
lifestyle-oriented cancers. The code was based on the
‘Europe against cancer’ campaign with the inclusion of
testicular cancer aimed at targeting young males.
Posters and leaflets were designed depicting the 10 points, and three TV
adverts were created to highlight the importance of nutrition and physical
activity as well as sun awareness and the dangers associated with smoking
and exposure to environmental tobacco smoke.
The campaign was formulated following discussions with the Malta Medical
Association. A guidebook for health professionals was also published to assist
primary care workers.
Health behaviour survey
Malta participated in the international health behaviour survey conducted at
national level among secondary school children. The survey comprised
approximately 60 questions, including sexual health questions for children
aged 13 and 15 years.
The raw data was sent to the international database centre in Norway for
analysis and for incorporation into the pooled data set.
I choose smoke free 2B trendy
A youth smoking prevention campaign was launched in December using the
public transport system in Malta. The slogan chosen, ‘I choose smoke free 2B
trendy’, was designed for an advert against a brand of cigarettes heavily
advertised to the local youth market at places of entertainment. In 2003 the
campaign will be introduced to schools and translated through various media.
Malta
Quit & Win
Malta organised its fifth Quit & Win campaign in conjunction with the National
Public Health Institute in Finland and also participated in the international
draw. Prizes for the competition reflected the promotion of physical activity to
coincide with the theme chosen by WHO for World Health Day. This year’s
Quit & Win attracted 750 applicants out of which six successful quitters
received a prize.
Sexual and reproductive health
The department focused on the training of personal and social life skills
teachers to enable them to teach sex education and discuss reproductive
health with their students. This exercise has been found to be very worthwhile
in the area of sexual health and is being strengthened by the compilation of a
national sexual health policy.
Further information:
The CINDI Programme in Malta is managed by the Health Promotion
Department of the Ministry of Health. For more information, please contact the
CINDI Programme Director, Ms Maria Ellul, Director of Health Promotion,
Health Promotion Department, 1 Crucifix Hill, Floriana CMR 02, Malta.
Tel: +356 221 890; Fax: +356 235 107; E-mail: maria.ellul@gov.mt
21

22
Republic of Moldova
Professor Mihail Popovici
Programme Executive Director
CINDI Programme activities in the Republic
of Moldova during 2002 included public
information about noncommunicable
diseases and hypertension management in
the CINDI demonstration area.
Nutrition
A key aim was to inform the public about the role
of unhealthy food in the development of
noncommunicable diseases. The research
undertaken in the CINDI demonstration area
provided information about high levels of unhealthy food consumption. The
public was informed about the necessity of decreasing fat intake and
increasing intake of fresh fruit and vegetables. Special educational
recommendations, booklets and medical bulletins were produced and
distributed.
Smoking
Highlights included activities at an individual and community level on tobacco
as a major risk factor. The government of Moldova decided to prohibit smoking
in public places.
Hypertension management
The incidence of hypertension and the level of related premature mortality was
high in the demonstration area. The prevalence of this risk factor was 30% in
the population aged 25 to 64. Two national conferences on hypertension
prevention and control, with the participation of health professionals and
pharmacists, were organised. Patients with hypertension in the demonstration
area were examined, establishing individual risk level, and treatment was
prescribed.
Further information
The CINDI Programme in the Republic of Moldova is managed by the Institute
of Cardiology team. For further information, please contact the CINDI
Programme Executive Director, Professor Mihail Popovici, 2025 Chisinau,
Testemitanu Street 29/1, Republic of Moldova. Tel: + 373 272 7511;
Fax: +373 273 9586; E-mail: mpopovici@mednet.md

Professor Wojciech
Drygas
Programme Director
The year’s highlights included work on physical
activity and anti-smoking campaigns, and the sixth
CINDI seminar and third CINDI risk factors and
health behaviours survey.
Physical activity campaign
The prevalence of sedentary lifestyles is still very high with
more than 70% of Poles not undertaking any kind of
exercise. The second phase of the national physical activity
campaign ‘Put your heart on its feet’ focused on
encouraging people to change behaviour and increasing public awareness of
the health benefits of regular physical activity. Thanks to the support of the
Pfizer Foundation and media, the campaign reached thousands of people in
40 centres throughout the whole country.
Smoking
The effective network of health professionals and Polish media encouraged an
estimated 6,000 people to give up smoking during the sixth national Quit &
Win smoking cessation campaign. Both of the above campaigns were
supported by the specially designed Physical activity guide and Internet guide
for smokers at the CINDI Poland web site: www.cindi.org.pl
Spala seminar
An estimated 150 participants at the Spala CINDI seminar benefited from the
presentation of the most successful initiatives in disease prevention as well as
from educational sessions and lectures given by Polish public health experts.
Winners of the most effective health promotion projects were awarded prizes
in the Professor Wlodzimerz Sapinski contest, named after the first CINDI
Poland director.
Health behaviour survey
The third random sample survey was carried out with a sample of 1,840
inhabitants from Lodz. The global risk of cardiovascular diseases decreased in
comparison to the previous survey results; however, a need to intensify efforts
in the management of hypertension and obesity still exists.
Poland
Further information
The CINDI Programme in Poland is managed by the Department of Social and
Preventive Medicine at the University of Medicine in Lodz. For more
information, please contact the CINDI Programme Director, Professor
Wojciech Drygas, Department of Social and Preventive Medicine, Medical
University, Zachodnia 81, Skr Pocz 4A, 90-955 Lodz, Poland. Tel: +48 42
632 6029/6721; Fax: +48 42 632 6029/2347; E-mail: office@cindi.org.pl
2
1
1. ‘Put your heart on its feet’ campaign poster
2. A winning entry to one of the competitions
23

24
Portugal
Professor Fernando
de Pádua
Programme Director
2002 CINDI activities in Portugal included those
carried out by health authorities in the
demonstration area, and by the National Institute of
Preventive Cardiology throughout the country.
CINDI protocol
The National Directorate of Health is studying the possibility
of extending collaboration with the World Health
Organization for a 10 year period.
Smoking
Smoking was one of the major topics of Portuguese activity. The Quit & Win
smoking cessation competition had substantial exposure and numerous
governmental and nongovernmental organisations participated. The mass
media gave good coverage and the number of participants who registered
increased. In conjunction with the campaign the National Institute of
Preventive Cardiology launched a ‘Quit line’ for the first time in Portugal.
International No Smoking Day and national non-smokers’ day were also
supported by CINDI in Portugal. A poster on smoking and pregnancy was
produced and distributed nationwide.
Smoking in schools was targeted by teachers through the National Institute of
Preventive Cardiology, the Department of Education throughout its network of
public schools, as well as by those in the CINDI demonstration area.
CINDI week
CINDI week focused on healthy lifestyles and on 15 years of programme
achievements. It took place in May and was again a true community-based
activity throughout the entire district (770,000 inhabitants). A scientific
meeting was part of CINDI week activities.
Other activities
The guidelines on health promotion and risk factor prevention and control
principles and strategies were produced and distributed among health
centres, regional health departments and community leaders. The publication
was a National Institute of Preventive Cardiology initiative. Cooperation with
major health bodies in Portugal and the mass media continue to be part of
CINDI Portugal’s work. It is important to recognise that health promotion and
noncommunicable disease prevention is now a reality in the health structure.
This was one of the major objectives of CINDI Portugal which has been
accomplished.
Further information
The CINDI Programme in Portugal is managed by the General Directorate of
Health and the National Institute of Preventive Cardiology. For more
information, please contact the CINDI Programme Director, Professor
Fernando de Pádua, National Institute of Preventive Cardiology, Av. Antonio
Serpa 26, 2nd floor, P-1050/027 Lisbon, Portugal.
Tel: +351 21 791 0160; Fax: +351 21 791 0169; E-mail: geral@incp.pt
1. Healthy activity during CINDI week
1

Dr Aura Marcu
Programme Director
CINDI activities in 2002 covered national campaigns
and activities in the Neamt demonstration area.
National activities
In 2002 national activities covered anti-smoking campaigns
and promoting cardiovascular disease (CVD) prevention. The
Ministry of Health and Family declared the third Thursday in
November as national No Smoking Day.
The national TV channel Romania 2 continued the anti-smoking campaign
‘Smokes are over’, running every day for 10 minutes. The TV station initiated
the campaign in 2001 with the Ministry of Health and Family and Aer Pur (the
nongovernmental organisation which was a co-organiser for Quit & Win in
2000 and 2002) acting as partners for the project.
The Romanian Parliament passed a law banning smoking in public places
which has been effective from December 2002. The Institute of Public Health
in Bucharest coordinated the Romanian Quit & Win contest for 2002, with a
sub-contest for health professionals. The ‘Day of the heart’ in September was
marked by the Minister of Health and Family at the 41st national congress of
cardiology.
Activities in Neamt
The intervention strategy in Neamt, a CINDI demonstration area, was
developed based on the results of the risk factors baseline evaluation. The
local CINDI team based in Neamt county health directorate has been working
in close contact with local administration and education authorities.
The activities in 2002 were:
• participation in the Quit & Win contest;
• education and information campaign on smoking cessation started in
May;
• campaigns aimed at CVD prevention - ‘A memorable day: the day you
quit smoking’, ‘Take care of your heart’, ‘Your health is up to you’;
• ‘Day of the heart’ activities: blood pressure and blood sugar
measurements for the general population, for the staff employed at
local governmental offices and at work places (timber industry);
Romania
• Distribution of health information materials on CVD risk factors,
diabetes, and the use of iodinated salt. The materials were distributed
to schools, medical institutions and workers involved in designing
and manufacturing these materials. Local media participaed in all the
activities.
The local CINDI coordinator of Bistrita-Nasaud county demonstration area has
published The health status in the real environment - a comprehensive report
on sociodemographic and health status of the population in the county. This
book is the first Romanian county report covering lifestyle, social,
demographic and health status aspects.
Further information
The CINDI Programme in Romania is managed by the Institute of Public
Health in Bucharest. For more information, please contact the CINDI
Programme Director, Dr Aura Marcu, Institute of Public Health, Str Dr Leonte
nr 1-3, 76256 Bucharest, Romania. Tel: +40 1 638 39 70/637 32 10; Fax:
+40 1 312 34 26; E-mail: amarcu@ispb.ro
1
1. CINDI coordinator - Dr Otilia and her team
25

26
Russian Federation
Professor Rafael
Oganov
Programme Director
CINDI Russia includes 18 regional programmes with
four new regions applying to join the programme. The
following activities were developed over the year:
healthy nutrition policy development, programme
system development for monitoring behavioural risk
factors, and the Quit & Win smoking cessation
campaign.
Healthy nutrition policy
Capacity development for assessment of actual nutrition among adults and
children from newborn to five years of age was continued in the northern cities
of Arkhangelsk and Murmansk. The report on nutrition and risk factors surveys
was put onto the WHO website. Methodology on nutrition assessment among
children from newborn to five years was developed. Surveys in the two cities
were conducted. WHO/UNICEF recommendations on healthy nutrition for
children were adopted and will be published in Russian for all CINDI Russia
centres.
Smoking
The fifth population-based Quit & Win smoking cessation campaign was
organised in Russia and 42,000 smokers joined the campaign. The campaign
was organised through central mass media and in 28 centres at regional and
local level. The campaign covered more than 28 million people, of whom
seven million were smokers over 18. The response rate among smokers was
0.6%.
For the first time an Internet site www.quitandwin.ru was established for
registration of Russian participants. More than 3,000 health professionals
participated in the campaign. The campaign was funded primarily from local
funds and partially by WHO and the Pharmacia pharmaceutical company.
Behavioural risk factors (BRF)
The guidelines on how to monitor behavioural risk factors were developed.
The Ministry of Health endorsed the guidelines for implementation in the
Russian Federation. Eleven CINDI regions carried out BRF surveys and the
data files were submitted to the CINDI Russia Coordinating Centre, Moscow.
A report of the Moscow survey was published and disseminated among
CINDI centres and health authorities.
Hypertension management
The 11-year collaboration between CINDI Pitkaranta (Karelia) and
CINDI Finland on high blood pressure control showed its first signs of
success. More people control high blood pressure effectively and, as a result,
systolic blood pressure has been decreased in the population.
Further information
The CINDI Programme in Russia is managed by the National Centre for
Preventive Medicine, Department of Policy and Strategy Development and
Health Promotion. For more information, please contact the CINDI Programme
Director, Professor Rafael G Oganov, CINDI Executive Director Professor Igor
S Glasunov, or CINDI Russia Coordinator, Dr Tatyana V Kamardina,
Petroverigsky Str.,10, 101953 Moscow, Russia. Tel/fax: +7 095 924 8988;
E-mail: cindirus@online.ru, oganov@online.ru or glasunov@comtv.ru
1
1. ‘Quit & Win’ winners draw, 31 May 2002

Dr Mária Avdicová
Programme Director
In 2002, activities of the CINDI programme were aimed
at supporting the ‘Tobacco-free Slovakia’ and ‘Healthy
children in healthy families’ projects. New monitoring
activities focused on health professionals who smoke
and data collection through the health monitor survey.
Tobacco-free Slovakia
Activities within the framework of the ‘Tobacco-free Slovakia’
project were concentrated on organisation of the national Quit & Win smoking
cessation competition. In total, 624 smokers participated in the competition.
The information campaign for the competition had a positive influence on
increasing activities at health counselling centres, where more and more
smokers visit in an attempt to stop smoking. ‘Stop smoking’ was also
established as the central theme of the fourth Healthy Lifestyle exhibition
which was held in Trencín ‘town of fashion’ in April.
Healthy children in healthy families
The epidemiological and clinical data needed for the primary prevention of
atherosclerosis were collected from 22,056 children from eight districts in
Slovakia. Cholesterol levels higher than 4.85 mmol/l in 11 year olds and
higher than 4.5 mmol/I in 17 year olds were found in 24.1% of 11 year olds
and 18.1% of boys and 30.4% of girls aged 17. Data from the questionnaire
and screening form describing lifestyle characteristics and post logistic
regression analysis are still being evaluated.
Quit & Win
Monitoring activities during the Quit & Win smoking cessation campaign were
focused on health care employees who smoke. This survey was carried out in
four districts within Slovakia. In May, data for the health monitor survey were
collected, with 3,000 questionnaires being distributed throughout the whole
country. The response rate was 52.6%. The first survey results were
presented at a workshop for CINDI programme activists from all 37 state
public health institutes in Slovakia.
Slovakia
Healthy lifestyle activities
During the year, health counselling centres in state public health institutes
undertook intense activities aimed at healthy lifestyle, using individual and also
group intervention methods.
Further information
The CINDI Programme in Slovakia is managed by the State Institute of Public
Health in Banská Bystrica and is supported by the Ministry of Health. For more
information, please contact the CINDI Programme Director, Mária Avdicová
MD, State Institute of Public Health, Cesta k nemocnici 1, Banská Bystrica
974 01. Tel: +421 48 4153261; Fax: +421 48 4123637;
E-mail: avdicova@szubb.sk
2
1 & 2. ‘Quit & Win’ campaign 2002 in Slovakia
1
27

28
Slovenia
Dr Jozica Maucec
Zakotnik
Programme Director
The year’s highlights for CINDI Slovenia included
primary prevention of chronic noncommunicable
disease, and training for health professionals.
CVD preventive programme
The national preventive programme of cardiovascular and
other chronic diseases for the adult population in primary
health care successfully continued countrywide. Medical
preventive check-ups for adults are followed by health
education programmes for patients at higher risk of CVD.
The main goal is to achieve positive changes in lifestyle
and lower early morbidity and mortality.
Local health information system (LIS)
CINDI Slovenia developed LIS to collect information related to
noncommunicable disease (NCD) risk factors and implemented it in every
family doctor practice. A system was also devised to collect data on risk
factors at the national level via the Internet and to create a register. In 2002,
25% of the adult population were screened.
CINDI Slovenia additionally trained health professionals for managing health
educational workshops in health care centres. There were workshops on
healthy slimming, healthy diet and smoking cessation, with 466 participants.
Nutrition
For World Nutrition Day in October, CINDI Slovenia held activities at national
and local level under the motto ‘Let’s begin the day with breakfast’ and
published a variety of posters, leaflets and booklets.
Physical activity
For the World Health Day theme ‘Move for health’, CINDI Slovenia delivered
different health promotion activities (walk tests, walking and cycling tours,
healthy lifestyle lectures) in collaboration with the Ministry of Health, the
Institute of Public Health, the Slovenian Heart Foundation and others.
In spring 2002 CINDI Slovenia also organised a 10 week walking programme
for 100 adult citizens of Ljubljana mainly with established risk factors for
chronic diseases. This included weekly walks, lectures on healthy lifestyle and
two walk tests (at the start and finish of the programme).
On average, participants managed to improve their physical fitness index by
five points.
Smoking
Slovenia joined the fifth international Quit and Win smoking cessation
campaign in May. After four weeks of smoking abstinence, 40% of 1,478 adult
participants defined themselves as non-smokers. Ten workshops on smoking
cessation in nine primary health care centres in Slovenia were organised in
parallel with the campaign.
International conference
CINDI Slovenia organised an international conference ‘Promoting health
through physical activity and nutrition’ which took place in Radenci in April.
International experts on health promotion, physical activity and nutrition took
part. A document The Radenci declaration, includes the most important
conference conclusions and is available on WHO websites.
Further information
The CINDI Slovenia Programme is managed by the National Health Insurance
Institute and the Ministry of Health. For more information, please contact the
CINDI Programme Director, Dr Jozica Maucec Zakotnik or CINDI Slovenia
Coordinator, Dr Dominika Novak Mlakar, Ministry of Health of Slovenia,
Stefanova 5, 1000 Ljubljana, Slovenia. Tel: +386 1 2517 884/or 4786 001;
Fax: +386 1 4786 079; E-mail: jozica.zakotnik@gov.si or cindi@zd-lj.si

Professor Lluís Salleras
Programme Director
This year’s CINDI highlights included work on
hypertension, tobacco, diabetes and physical activity.
Hypertension
Hypertension control is still a problem in CINDI countries
and uncontrolled hypertension is a major risk factor for
cardiovascular diseases. With the aim of improving
hypertension management in the community, a hypertension
management programme, in collaboration with community
pharmacies and primary health care teams, is being carried
out in the CINDI Catalonia demonstration area of Girona. This programme is a
joint CINDI-EuroPharm Forum project.
Tobacco
A smoking cessation programme with reimbursement in three pilot areas was
carried out. The project was possible thanks to the cooperation of community
pharmacists with primary health care teams in the pilot areas.
Diabetes mellitus
Continuing with the tradition started in 1981 of summer camps for diabetic
children these were held during July with the aim of helping diabetic children
assume the self-management of type 1 diabetes.
Physical activity
A low level of physical activity has been observed in the Catalonian
population. Therefore with the objective of promoting more active leisure time,
an agreement with the Catalan Federation of Walking Association was
reached to conduct more than 300 popular walks throughout Catalonia.
Further information
The CINDI Programme in Catalonia (Spain) is managed by the Department of
Health and Social Security of the Autonomous Government of Catalonia. For
more information, please contact the CINDI Programme Director, Professor
Lluís Salleras, Director General, Generalitat de Catalunya, Department of
Health and Social Security, Pavello Ave Maria, Travessera de les Corts, 131-
159, E-08028 Barcelona, Catalonia, Spain. Tel: +34 93 227 29 00 ; Fax:
+34 93 227 29 90; or Professor Helios Pardell, CINDI Executive Director,
E-mail: rtresser@dsss.scs.es
1 2
1. Smoking cessation poster
2. Hypertension leaflet
Spain (Catalonia)
29

30
Turkmenistan
Dr Rustam Kazimov
Programme Director
The year’s highlights included activities focused on
tobacco control, youth education, physical activity
and intersectional partnership strengthening.
Tobacco control
The 2002 Quit & Win smoking cessation campaign was
held for the fourth time. More than 2,800 smokers tried to
quit smoking during the campaign, with 90% of participants
registered by family doctors directly. The competition
finished on 31 May with a concert of amateur artists from
medical schools and a prize presentation to the winners and to medical
institutions which registered the most participants.
With support from the WHO Regional Office for Europe, a resource centre on
tobacco control was established to assist the Framework Convention on
Tobacco Control (FCTC) with the aim of improving activities on tobacco
control in the country. A seminar was held jointly with the Saglyk national
centre for regional press-centers on the subject of tobacco control problems
and solutions.
Youth education
Additional literature on healthy lifestyle issues and popular periodicals for
young people were added to the library of the CINDI information centre. A
series of booklets on nutrition, physical activity, smoking prevention among
young people and methods of smoking cessation was produced.
Physical activity
In collaboration with the country’s Olympics committee, work on improving
access of young people to sport was carried out. Participation in an
international conference ‘Education through sport’ in Wiesbaden took place
and a publication of the same name was produced with strategic cooperation
for the objective being defined.
With the aim of encouraging sport among children, the CINDI team also
issued monthly tennis bulletins.
Inspection of the selection of physical activity representatives, covering 2,500
people in five regions of the country, was made with the support of the
WHO Regional Office for Europe.
Intersectional partnership
There was CINDI-Turkmenistan participation in the World Bank assembly ‘Civil
society driving development’ in Belgrade in support of the nongovernmental
organisations (NGOs) sector development. As a result, a coordination council
was created and consultations carried out with NGOs operating in the health
protection sector. There was also active work and collaboration on
strengthening the NGOs’ role in prevention of noncommunicable diseases
and promotion of healthy lifestyles.
Further information
The CINDI Programme in Turkmenistan is managed by the Educational
Information Centre for Health Promotion and Prevention. General management
is by the Ministry of Health and the medical industry. For more information,
please contact the CINDI Director, Dr Rustam Kazimov, Chief, Turkmenistan
Research Institute of Preventive and Clinical Medicine, Educational and
Information Centre, Health Promotion and Prevention Ul, 1 Maya 31, Ashgabat
744006, Turkmenistan. Tel/fax: +993 12 44 47 65;
E-mail: prevhealth@cpart.asb.tm

Professor Iryna
Smyrnova
Programme Director
The year’s highlights included work on smoking,
hypertension and nutrition.
Smoking
There are about nine million smokers in Ukraine. Data
highlight smoking as the cause of one fifth of all mortality
cases annually among people over 35 years of age. The
International Quit & Win smoking campaign became one of
the most important and helpful activities for people who
wanted to give up smoking. In the 2002 campaign, 16,957
people from 23 regions of Ukraine, comprising 0.19% of smokers over the
age of 35, took part. One in 10 campaign participants worked in the medical
field.
In connection with the Quit & Win contest, a social programme ‘The step to
health’ was conducted. Specially trained professionals ran smoking cessation
programmes in polyclinics and health centres. Within the campaign
framework, a children’s contest for the best drawing ‘Smoking as seen by
children’ was conducted. The guidelines for GPs on smoking prevention and
smoking cessation were published.
Hypertension
In April 2002 the national conference ‘Prevention and treatment of arterial
hypertension in Ukraine’ within the framework of the national programme
realisation’ was held in Kiev. The main results and problems of a three year
period of implementation of the national programme were discussed. At the
conference the issue of measuring blood pressure by pharmacists with
preventive activities among patients was examined. A poster was also
produced to inform the population about the importance of measuring blood
pressure.
Nutrition
CINDI Ukraine has initiated discussions about the promotion of a national
healthy nutrition programme. Knowledge about healthy nutrition was
disseminated to the general public as well as to medical staff and a major
public information campaign through television and radio coverage took place.
Ukraine
Further information
The CINDI Programme in Ukraine is managed by the Ministry of Public Health
with support from the World Health Organization. The Ministry of Public
Health has established a CINDI coordinating council and work is being
carried out by the Ukrainian Institute of Cardiology, the Kharkiv Institute of
Therapy, the Dnipropetrovsk and Ivano-Frankivsk Medical Academies and the
statistical department of the Ministry of Public Health. For more information,
please contact the CINDI Executive Director, Professor Iryna Smyrnova, the
Research Institute of Cardiology, Narodnogo Opolcheniya St. 5; 03151 Kiev,
Ukraine. Tel: +380 44 249 7036/7038; Fax: +380 44 277 4209; E-mail:
depi@alfacom.net
1
1. A poster outlining the importance of measuring blood pressure
31

32
United Kingdom (Northern Ireland)
Dr Brian Gaffney
Programme Director
Among the highlights of 2002 were initiatives on
nutrition, physical activity, drugs and smoking by
the Health Promotion Agency, which coordinates
the CINDI programme work in Northern Ireland.
Nutrition
Many of the year’s initiatives focused on supporting
healthier eating for young people. The Agency worked to
encourage collaboration between the many sectors,
organisations and people who influence food choices.
A report Learning to eat well: nutrition initiatives in schools
detailed healthy eating initiatives in local schools. Getting a good
start - healthy eating from one to five was developed as a nutrition
information booklet for parents. Nutrition matters for the early years
outlined comprehensive guidance for childcare providers. Fresh Fruit
in Schools, featuring the Snack Pack characters, an initiative to provide
a free fresh piece of fruit to children in primary schools, was also launched.
The Agency worked in an advisory capacity with the Department of Education
to support the development of nutritional standards for school meals, and the
community-based nutrition programme Cook It! was revised to include
advances in nutrition knowledge and education.
Physical activity
Work to improve the level of inactivity in the population by facilitating the
Northern Ireland Physical Activity Strategy continued. The third phase of the
‘Get a life, get active’ campaign was also initiated, with the ‘Go walking’
advertisement televised.
Work with the Republic of Ireland led to an all-island physical activity
conference in November. Entitled ‘Getting active together! Promoting good
practice in physical activity’ it identified principles of good practice in physical
activity and explored how all sectors could collaborate to address growing
levels of physical inactivity.
The Health Promotion Agency and a local education board launched Class
Moves! - a Dutch initiative which introduces short sessions of physical activity
into the primary school classroom to help children and teachers benefit from
activity and relaxation.
Drugs
Work supported the objectives contained in the regional Drugs and Alcohol
Strategy and included the development for professionals and young people of
a new drugs prevention website www.drugsprevention.net on the harmful
effects of drugs.
Qualitative research across Northern Ireland was carried out to assess current
knowledge of volatile substance abuse and future information needs, with a
summary report published in March 2002. The public information campaign on
drugs targeting 18-30 year olds also continued, with posters and leaflets
promoting the National Drugs Helpline.
A public information campaign providing factual information on ecstasy, speed
and LSD targeted teenagers and was supported by an information booklet.
Smoking
The first phase of a public information campaign for adults was launched. A
series of television advertisements was broadcast during the first three
months of the year and the main advertisement was adapted from a
successful anti-smoking campaign in Australia built around the slogan Every
cigarette is doing you damage.
Further information
The CINDI Programme work in Northern Ireland is coordinated by the Health
Promotion Agency. For more information, please contact the CINDI Programme
Director, Dr Brian Gaffney, Chief Executive, Health Promotion Agency for
Northern Ireland, 18 Ormeau Avenue, Belfast BT2 8HS, Northern Ireland. Tel:
+44 28 9031 1611; Fax: +44 28 9031 1711; E-mail: b.gaffney@hpani.org.uk
1 2
1. The launch of the Fresh Fruit in Schools initiative.
2. The artery advertisement from the ‘Every cigarette is doing you damage’ campaign

The National Public Health Institute (KTL) in Finland has been
coordinating International Quit & Win contests since 1994 when 13
WHO CINDI participating countries organised the first Quit & Win
smoking cessation campaign.
2002 campaign
International Quit & Win 2002, carried out in May, attracted some 660,000
smokers in 77 countries worldwide. All 27 CINDI countries organised their
own Quit and Win contest, with a total of 267,171 participants. An optional
contest for health professionals was also organised in 15 CINDI countries,
aimed at helping health professionals stop smoking and recognise the crucial
role they have as role models for their patients.
The prizes for Quit & Win 2002 were drawn at the annual meeting of CINDI
Programme Directors in Nicosia, Cyprus in June 2002. The super prize (USD
10,000) winner was Mr Jean Lessard from Quebec, Canada. Six regional
prizes (USD 2,500 each) went to the national winners of Mauritius, Iran,
Germany, Cuba, Indonesia and China. The international prize for the optional
contest for health professionals (USD 2,500) went to Lithuania.
Follow-up results
At the one year follow-up, an estimate of the participants who were still nonsmokers
was 15-20%. Detailed data about the results and experiences of the
previous International Quit & Win contests are published and can be obtained
from the International Quit & Win coordinating centre.
International Quit & Win Growth
Countries
90
80
70
60
50
40
30
20
10
0
1994 1996 1998 2000 2002
Year
700000
600000
500000
400000
300000
200000
100000
0
Participants
Countries
Participants
International Quit & Win
Table 1. Quit & Win 2000 and 2002 in CINDI countries
2000 2001 2002 2002
One year Health
Country Participants abstinence Participants professional
rate % participants
Austria - - 1,561 -
Belarus 4,947 28.0 8,308 -
Bulgaria 3,601 26.0 4,261 867
Canada 33,816 31.0 38,200 -
Croatia 308 - 586 -
Cyprus 109 - 677 39
Czech Rep. 2,024 15.4 1,518 34
Estonia 481 19.3 318 -
Finland 6,064 11.9 6,934 738
Germany 24,925 20.0 90,458 -
Hungary 7,831 12.3 4,205 986
Italy 5,938 44.2 6,368 623
Kazakhstan 5,891 35.0 20,743 -
Kyrgyzstan 10,033 - 962 -
Latvia 824 14.3 234 16
Lithuania 911 9.4 522 87
Malta 1,235 12.4 602 -
Poland 3,730 43.0 6,000 575
Portugal 1,215 - 1,764 -
Romania 1,323 7.2 1,412 160
Russian
Federation
28,407 16.0 41,780 3,354
Slovakia 1,657 13.6 626 60
Slovenia 700 - 1,416 74
Spain (Catalonia) 8,590 16.7 7,069 637
Turkmenistan
United Kingdom
2,566 - 2,810 -
(Northern Ireland) 3,500 - 2,157 -
Ukraine 14,492 25.0 15,680 1,050
33

34
CARMEN highlights
Conjunto de
Acciones para la
Reducción
Multifactorial de las
Enfermedades
No transmisibles
A Spanish acronym for
a set of actions for the multifactoral
reduction of noncommunicable diseases
The Pan American Health Organization (PAHO), the Regional Office for the
Americas of the World Health Organization (WHO), has identified programme
objectives and policies that seek to effectively prevent and control
noncommunicable diseases (NCDs) in the Americas. The recommendations
include a variety of strategies to reduce the burden of NCDs, and reliance on
the implementation of integrated community-based prevention projects, known
as CARMEN.
The goal of the CARMEN initiative is to improve the health status of targeted
populations by reducing the prevalence of risk factors associated with NCDs.
This is attained through integrated health promotion and disease prevention at
the community level and through the health care services. Noncommunicable
diseases share several common risk factors that show interactive, addictive,
and synergistic characteristics, and therefore by preventing one risk factor it is
possible to help prevent several noncommunicable diseases simultaneously.
CARMEN is responding to the current NCD epidemic and to the needs of the
Americas by striving to develop, implement and evaluate:
• policies aimed at simultaneously reducing a set of common NCD risk
factors;
• social mobilisation and community-based interventions;
• epidemiological surveillance systems for risk conditions; and
• clinical prevention practices that can contribute to the reduction of
health inequalities.
The CARMEN initiative maintains three strategies to achieve the
aforementioned objectives:
1. Integrated prevention and health promotion - through combined and
balanced efforts for preventative health care and general health promotion,
communities will be able to become active participants in decisions
concerning their health;
2. The establishment of demonstration areas - interventions are first
introduced in demonstration areas so that acceptability, safety, and ultimate
effectiveness can be evaluated in a given context;
3. The promotion of health equity - prevention strategies should consider
underlying influences on health inequalities as it is critical that strategies be
aimed at reducing overall population risk and, at the same time, reduce the
health gap among different population groups.
CARMEN is rooted in the following concurrent lines of action: policy building,
community-based action, and responsive health services. The initiative
believes that specific policy analysis must begin at the country level. However,
there are also key policies that demand a drive for consensus with
international and transnational stakeholders. Since participation in major
international initiatives is central in placing NCD prevention on the public
agenda, CARMEN programmes seek contributions from all sectors of society
for successful policy building processes.
To ensure integrated prevention initiatives, CARMEN programmes look for
effective involvement of families and communities, working together to pool
and share resources. The health sector becomes a partner rather than the
leader of the intervention, since local coalitions ensure that all involved
organisations and professionals are trained and provided with technical
assistance in coalition development, community planning, and programme
implementation.
In addition, the CARMEN initiative maintains that health services should shift
their focus from episodic care for acute illnesses to a more proactive
approach that considers participation in prevention programmes and the
needs of persons with chronic conditions.

It is hoped to achieve the three main strategies of the CARMEN initiative
through increasing the technical capacity of the countries for the prevention of
NCD risk factors in the Americas. Therefore, CARMEN has a technical
component that seeks to:
• promote and support cost-effective interventions for NCD prevention;
• develop adequate strategies and methodologies for NCD prevention,
considering the countries’ unique characteristics;
• develop strategies to obtain the support of legislators and other key
players;
• encourage and support community participation in NCD prevention
initiatives; and
• promote a regional agenda for tackling the NCD epidemic.
The primary strategy developed to achieve the objectives of the CARMEN
technical component is the promotion and support of networking among
member countries in the area of NCD prevention. The CARMEN network
seeks to build a bridge that can integrate both activities outside the health
sector that can have an important impact on underlying risk conditions, and
activities on health services in order to establish a coherent public health
program that addresses the common risk conditions for NCDs.
Therefore, the CARMEN network acts simultaneously at three different levels:
in public policy, nationally and internationally; in the community, considering
the culture, values and social organisation of the different population groups;
and in the incorporation of preventive services within health care and other
social institutions.
The CARMEN network is also part of a global NCD prevention family and is
linked to the other WHO regional networks and to the global forum on NCD
prevention and control. In this framework, the CARMEN network promotes the
exchange of knowledge and experiences between countries and regions,
addresses problems, and supports collaboration to tackle the increasing
burden of disease due to NCDs.
CARMEN highlights
Carmen members, prospective members and special
projects.
Diagram 1 Key
Members
Argentina, Brazil,
Canada, Chile,
Costa Rica, Cuba,
Columbia, Peru
Prospective Members
El Salvador,
Guatemala,
Nicaragua, Panama,
Venezuela
Special Projects
USA/Mexico (border)
CARLI (English
Caribbean,
Netherlands)
Other Countries
35

36
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Designed and produced by:
The Health Promotion Agency for Northern Ireland.
www.healthpromotionagency.org.uk
03/03