Local prevention

This will presumably be the dominating method in raising new tasks of medical prevention in the years to come. There are three reasons for that:

• Individual moralism has lost its effects and can no longer be the main methods in prevention.

• Municipalities have the responsibility for prevention and are our employers but is mainly speaking not interested in prevention. The reasons are, first, that it costs money, and secondly that preventive measures give handicaps in completion among small units.

• The Government has always been the motor in prevention because the state may plan for a long period and is not subject to completion. When we no longer can relay on new governmental rules the reason is that the Government has turned out to be too weak for new efforts in medical prevention.

Physicians and others who are interested in new preventive measures must go together with local groups. That may be within the municipal administration but will probably be in smaller units like schoolchildren and their parents, a neighbourhood, a local association, or among employees in a company.

What is HUBRO?

All inhabitants of Oslo in the age groups 15, 30, 40, 45, 60 and 75 years in 2000 were offered a health control, in all 40,000 individuals. 8,000 of those 15 years old participated (89 %), because the examination was done at school in 10th grade. Of the adults 18,800 participated (46 %).

Data from Statistics Norway were linked to all 40,000. Hence we know a lot about the representativity, and that is quite good.

When considering possibilities for prevention, representativity is no big problem, but more that it is a cross-sectional study. We cannot draw conclusions about courses of disease, and thus we cannot conclude that certain measures will be preventive. Only for the teenagers we have a follow-up examination after three years, then finding most of them in secondary school.

What we can and shall do, is to make it probable that some measure will have preventive effects. In a healthy population as that of Oslo, which also is a well organised city, the most important variables are:

Social Ethnicity, education, family status, occupation, social security benefits, taxable income, assets.

Housing Ownership, number of rooms, equipment, area of living, migration, linked municipal data (air pollution, green areas, sport clubs in the neighbourhood).

Medical General self-reported health, mental symptoms, musculoskeletal complaints, angina pectoris, chronic obstructive lung diseases and some other chronic diseases.

Psychosocial conditions Mastering, powerlessness, collective actionism, social anxiety, type behaviour, life events.

Working conditions Job control, physically strenuous work, shift work.

Here are large possibilities. Only some relations will be studied, mostly according to the interests of the researchers. From a preventive point of view, it is simplest to look at diversities by neighbourhoods, i.e. local prevention:

• Do we find some school districts where youth health is better than expected according to individual characteristics? Are some patterns of transitions from primary to secondary school especially positive? What characterise these schools? (No names!).

• Do we find the same for some neighbourhoods (in Oslo about 80 with around 6,000 inhabitants in each)?

• How is lifestyle in different social groups, ethnicity and areas of living? Do we find patterns that should lead to structural measures? (New sport stadiums for instance for fighting and motor sports, collective trim efforts like «Romsås in motion», new «neighbourhood houses», new talking groups in the health stations, advertisements for smoking cessation courses in certain occupational groups).

• Are anxious youths more passive in certain neighbourhoods than in others? (New kinds of youth clubs, open schools in the afternoon).

This list contains only small and modest proposals which all are relatively simple to put into action together with local support. More important measures will probably raise constraints and will demand more powerful actions. That may be the case of dangerous traffic in the neighbourhoods, air pollution, dangerous working conditions and different aspects of living conditions for children.