Population-level changes to promote cardiovascular health

Czech version

Authors: T. Jørgensen ^1,2,3; S. Capewell ⁴; E. Prescott ⁵; S. Allender ⁶; S. Sans ⁷; T. Zdrojewski ⁸; D. De Bacquer ⁹; J. De Sutter ⁹; O. H. Franco ^10,11; S. Løgstrup ¹²; M. Volpe ^13,14; S. Malyutina ¹⁵; W. M. M. Verschuren ¹⁹; D. Vanuzzo (jménem Oddělení Pep Eacpr) ²⁰
Authors‘ workplace: Výzkumné středisko pro otázky prevence a zdraví Glostrup, Dánsko ¹; Univerzita v Kodani, Dánsko ²; Univerzita v Aalborgu, Dánsko ³; Univerzita Liverpoolu, Velká Británie ⁴; Bispebjergská univerzitní nemocnice Kodaň, Dánsko ⁵; Univerzita v Oxfordu, Velká Británie ⁶; Ústav pro problematiku zdravotnictví Barcelona, Španělsko ⁷; Lékařská univerzita v Gdaňsku, Polsko ⁸; Univerzita v Ghentu, Belgie ⁹; Univerzita v Cambridgi, Velká Británie ¹⁰; Erasmova Univerzita Rotterdam, Nizozemsko ¹¹; European Heart Network Brusel, Belgie ¹²; Univerzita Sapienza, Nemocnice Sant’Andrea, Řím ¹³; IRCCS Neuromed, Pozzilli, Itálie ¹⁴; Sibiřská pobočka Ruské akademie lékařských věd Novosibirsk, Rusko ¹⁵; Univerzitní nemocnice v Lausanne, Švýcarsko ¹⁶; Univerzita v Záhřebu, Chorvatsko ¹⁷; Univerzita v Bergenu, Norsko ¹⁸; Státní ústav veřejného zdraví a životního prostředí Bilthoven, Nizozemsko ¹⁹; Medio Friuli Udine, Itálie ²⁰
Published in: Vnitř Lék 2012; 58(12): 943-954
Category: Review

Overview

Background:
Cardiovascular diseases (CVD) cause 1.8 million premature (<75 years) death annually in Europe. The majority of these deaths are preventable with the most efficient and cost-effective approach being on the population level. The aim of this position paper is to assist authorities in selecting the most adequate management strategies to prevent CVD.

Design and methods:
Experts reviewed and summarized the published evidence on the major modifiable CVD risk factors: food, physical inactivity, smoking, and alcohol. Population-based preventive strategies focus on fiscal measures (e.g. taxation), national and regional policies (e.g. smoke-free legislation), and environmental changes (e.g. availability of alcohol).

Results:
Food is a complex area, but several strategies can be effective in increasing fruit and vegetables and lowering intake of salt, saturated fat, trans-fats, and free sugars. Tobacco and alcohol can be regulated mainly by fiscal measures and national policies, but local availability also plays a role. Changes in national policies and the built environment will integrate physical activity into daily life.

Conclusion:
Societal changes and commercial influences have led to the present unhealthy environment, in which default option in life style increases CVD risk. A challenge for both central and local authorities is, therefore, to ensure healthier defaults. This position paper summarizes the evidence and recommends a number of structuralstrategies at international, national, and regional levels that in combination can substantially reduce CVD.

Key words:
cardiovascular, health promotion, population, prevention, public health, structural strategies

Sources

1. Beaglehole R, Bonita R, Horton R et al. Priority actions for the non-communicable disease crisis. Lancet 2011; 377: 1438–1447.

2. Graham I, Atar D, Borch-Johnsen K et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2007; 14: (Suppl 2): E1–E40.

3. Reiner Z, Catapano AL, De Backer G et al. ESC/EAS Guidelines for the management of dyslipidaemias: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011; 32: 1769–1818.

4. National Institute for Health and Clinical Excellence. Prevention of cardiovascular disease at population level. NICE public health guidance 25. 2010. [on-line] http://www.nice.org.uk/nicemedia/live/13024/49274/49274.pdf

5. World Health Organization. The European Health Report. Health and Health System, 2009: 1–191. [on-line] http://www.euro.who.int/__data/assets/pdf_file/0009/82386/E93103.pdf

6. World Health Organization. European Health for All Database (HFA-DB). 2011. [on-line] http://data.euro.who.int/hfadb/

7. Bobak M, Murphy M, Rose R, Marmot M. Societal characteristics and health in the former communist countries of Central and Eastern Europe and the former Soviet Union: a multilevel analysis. J Epidemiol Community Health 2007; 61: 990–996.

8. Boylan S, Welch A, Pikhart H et al. Dietary habits in three Central and Eastern European countries: the HAPIEE study. BMC Public Health 2009; 9: 439.

9. Bandosz P, O‘Flaherty M, Drygas W et al. Explaining the decline in coronary heart disease mortality in Poland between 1991 and 2005. BMJ 2012; In Press.

10. Unal B, Critchley JA, Capewell S. Explaining the decline in coronary heart disease mortality in England and Wales between 1981 and 2000. Circulation 2004; 109: 1101–1107.

11. European Heart Network. CVD statistics 2008. [on-line] www.ehnheart.org/cvd-statistics.html

12. He FJ, MacGregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens 2009; 23: 363–384.

13. Fung TT, Malik V, Rexrode KM et al. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr 2009; 89: 1037–1042.

14. Harris JL, Schwartz MB, Brownell KD et al. Rudd Center for Food Policy and Obesity. Fast Food Facts: Evaluating fast food nutrition and marketing to youth 2010. [on-line] http://www.fastfoodmarketing.org/media/FastFoodFACTS_Report.pdf

15. Malik VS, Popkin BM, Bray GA, Després JP, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation 2010; 121: 1356–1364.

16. Scottish Intercollegiate Guidelines Network. Risk estimation and the prevention of cardiovascular disease, A national clinical guideline 97. 2007. [on-line] http://www.sign.ac.uk/pdf/sign97.pdf

17. Nocon M, Hiemann T, Müller-Riemenschneider F et al. Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil 2008; 15: 239–246.

18. Sattelmair J, Pertman J, Ding EL et al. Dose response between physical activity and risk of coronary heart disease: a meta-analysis. Circulation 2011; 124: 789–795.

19. Frydenlund G, Jørgensen T, Toft U, Pisinger C, Aadahl M. Sedentary leisure time behavior, snacking habits and cardiovascular biomarkers: the Inter99 Study. Eur J Prev Cardiol 2012; 19: 1111–1119.

20. Grøntved A, Hu FB. Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: a meta-analysis. JAMA 2011; 305: 2448–2455.

21. Corrao G, Rubbiati L, Bagnardi V, Zambon A, Poikolainen K. Alcohol and coronary heart disease: a meta-analysis. Addiction 2000; 95: 1505–1523.

22. Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ 2011; 342: d671.

23. Brien SE, Ronksley PE, Turner BJ, Mukamal KJ, Ghali WA. Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies. BMJ 2011; 342: d636.

24. Rose GA. The Strategy of Preventive Medicine. Oxford: Oxford University Press 1992: 138 s.

25. Ebrahim S, Taylor F, Ward K et al. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database Syst Rev 2011; (1): CD001561.

26. Glass TA, McAtee MJ. Behavioral science at the crossroads in public health: extending horizons, envisioning the future. Soc Sci Med 2006; 62: 1650–1671.

27. Greater than the Sum. Systems Thinking in Tobacco Control. Best A, Clark PI, Leischow SJ, Trochim WM, editors. National Cancer Institute, U.S. Department of Health and Human Services. National Institutes of Health. 2007: 294 s.

28. Atella V, Brady A, Catapano AL et al. Bridging science and health policy in cardiovascular disease: focus on lipid management: A Report from a Session held during the 7th International Symposium on Multiple Risk Factors in Cardiovascular Diseases: Prevention and Intervention – Health Policy, in Venice, Italy, on 25 October, 2008. Atheroscler Suppl 2009; 10: 3–21.

29. Jahiel RI, Babor TF. Industrial epidemics, public health advocacy and the alcohol industry: lessons from other fields. Addiction 2007; 102: 1335–1339.

30. World Health Organization. WHO Technical Report Series. WHO expert committee on problems related to alcohol consumption 2011.

31. Gilmore AB, Savell E, Collin J. Public health, corporations and the new responsibility deal: promoting partnerships with vectors of disease? J Public Health (Oxf) 2011; 33: 2–4.

32. Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. Lancet 2010; 376: 1261–1271.

33. Franco M, Orduñez P, Caballero B et al. Impact of energy intake, physical activity, and population-wide weight loss on cardiovascular disease and diabetes mortality in Cuba, 1980–2005. Am J Epidemiol 2007; 166: 1374–1380.

34. Mozaffarian D, Capewell S. United Nations‘ dietary policies to prevent cardiovascular disease. BMJ 2011; 343: d5747.

35. World Health Organization. Diet, nutrition and the prevention of chronic diseases. Report of a Joint WHO/FAO Expert Consultation. Geneva 2003.

36. National Heart Forum. National Heart Forum position paper on the elimination of industrially-produced trans fats (IPTFAs) from foods consumed in the UK. 2010. [on-line] http://nhfshare.heartforum.org.uk/RMAssets/NHFpositionstatements/NHF_position_paper_on_IPTFAs_June_2010.pdf

37. Hawkes C. Promoting healthy diets and tackling obesity and diet-related chronic diseases: what are the agricultural policy levers? Food Nutr Bull 2007; 28: (Suppl 2): S312–S322.

38. European Commission. Agriculture and Rural Development. The Common Agricultural Policy after 2013. Public debate. Summary report 2010. [on-line] http://ec.europa.eu/agriculture/cap-post-2013/debate/report/summary-report_en.pdf

39. European Heart Network. Fighting heart disease and stroke. Diet, physical activity and cardiovascular disease prevention in Europe 2011. [on-line] http://www.ehnheart.org/euro-heart-ii/publication/523-diet-physical-activity--and-cardiovascular-disease-prevention.html

40. Lock K, Pomerleau J, editors. 2005. European Heart Network. Fruit and vegetable policy in the European Union: its effect of the burden of cardiovascular disease. London; 2005. [on-line] http://www.ehnheart.org/publica%25ADtions/publications/publication/114-fruit-and--vegetable-policy-in-the-european-union.html

41. Mytton O, Gray A, Rayner M, Rutter H. Could targeted food taxes improve health? J Epidemiol Community Health 2007; 61: 689–694.

42. Fletcher JM, Frisvold D, Tefft N. Taxing soft drinks and restricting access to vending machines to curb child obesity. Health Aff (Millwood) 2010; 29: 1059–1066.

43. Thow AM, Quested C, Juventin L et al. Taxing soft drinks in the Pacific: implementation lessons for improving health. Health Promot Int 2011; 26: 55–64.

44. Sturm R, Datar A. Regional price differences and food consumption frequency among elementary school children. Public Health 2011; 125: 136–141.

45. Hawkes C. Regulating and litigating in the public interest: regulating food marketing to young people worldwide: trends and policy drivers. Am J Public Health 2007; 97: 1962–1973.

46. Finland Agricultural Policy. Revised 10th November 2004. [on-line] http://www.photius.com/countries/finland/economy/finland_economy_agricultural_policy.html

47. Laatikainen T, Critchley J, Vartiainen E et al. Explaining the decline in coronary heart disease mortality in Finland between 1982 and 1997. Am J Epidemiol 2005; 162: 764–773.

48. Pan American Health Association. Penney S. Dropping the salt. Practical steps countries are taking to prevent chronic non-communicable diseases through population-wide salt reduction. 2009. [on-line] http://www.paho.org/english/ad/dpc/nc/salt-mtg-phac-paper.pdf

50. He FJ, MacGregor GA. Reducing population salt intake worldwide: from evidence to implementation. Prog Cardiovasc Dis 2010; 52: 363–382.

51. Bibbins-Domingo K, Chertow GM, Coxson PG et al. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med 2010; 362: 590–599.

52. Barton P, Andronis L, Briggs A, McPherson K, Capewell S. Effectiveness and cost effectiveness of cardiovascular disease prevention in whole populations: modelling study. BMJ 2011; 343: d4044.

53. Cobiac LJ, Vos T, Veerman JL. Cost-effectiveness of interventions to reduce dietary salt intake. Heart 2010; 96: 1920–1925.

54. Boyland EJ, Harrold JA, Kirkham TC, Halford JC. The extent of food advertising to children on UK television in 2008. Int J Pediatr Obes 2011; 6: 455–461.

55. Linn SE. Food marketing to children in the context of a marketing maelstrom. J Public Health Policy 2004; 25: 367–378.

56. Independent regulator and competition authority for the UK communications industries. HFSS advertising restrictions – Final review 2010. [on-line] http://stakeholders.ofcom.org.uk/market-data-research/other/tv-research/hfss-final-review/

57. Australia New Zealand Food Standards Authority, editor. On-going food label monitoring survey in Australia and New Zealand. Report on the re-assessment of 2003 labels for nutrition, health and related claims. Phase 2, Part C. 2005. AgriQuality Pty Ltd, prepared for FSANZ, Canberra.

58. European Heart Network. Food information to consumers. EHN research on consumer preferences and use of Front of Pack nutrition schemes 2010. [on-line] http://www.ehnheart.org/publications/position-papers/publication//18-good-information-to-consumers.html

59. Nordic Council of Ministers. About the Keyhole [on-line]. http://www.norden.org/en/nordic-council-of-ministers/council-of-ministers/council-of-ministers-for-fisheries-and-aquaculture-agriculture-food-and-forestry-mr-fjls/keyhole-nutrition-label/about-the-keyhole

60. Nelson M, Nicholas J, Wood L, Katy R, Russel S. Take up of school lunches in England 2010–2011. 2011. School Food Trust. Eat better do better.

61. Lissau I, Poùlsen J. Nutrition policy, food and drinks at school and after school care. Int J Obes (Lond) 2005; 29: (Suppl 2): S58–S61.

62. Toh CM, Cutter J, Chew SK. School based intervention has reduced obesity in Singapore. BMJ 2002; 324: 427.

63. Larson NI, Story MT, Nelson MC. Neighborhood environments: disparities in access to healthy foods in the U.S. Am J Prev Med 2009; 36: 74–81.

64. Roos E, Sarlio-Lähteenkorva S, Lallukka T. Having lunch at a staff canteen is associated with recommended food habits. Public Health Nutr 2004; 7: 53–61.

65. Sturm R, Cohen DA. Zoning for health? The year-old ban on new fast-food restaurants in South LA. Health Aff (Millwood) 2009; 28: w1088–w1097.

66. Gallus S, Tramacere I, Boffetta P et al. Temporal changes of under-reporting of cigarette consumption in population-based studies. Tob Control 2011; 20: 34–39.

67. Health effects of exposure to environmental tobacco smoke. California Environmental Protection Agency. Tob Control 1997; 6: 346–353.

68. Tobacco smoke and involuntary smoking. IARC Monogr Eval Carcinog Risks Hum 2004; 83: 1–1438.

69. World Health Organization. WHO Framework Convention on Tobacco Control. Guidelines for implementation. Article 5.3, Article 8, Articles 9 and 10, Article 11, Article 12, Article 13, Article 14. 2011.

70. Smoke Free Partnership. Spotlight 4 – Rates and structure of tobacco taxes. [on-line] http://www.smokefreepartnership.eu/documents/spotlight-4-rates-and-structure-tobacco-taxes

71. Response to increases in cigarette prices by race/ethnicity, income, and age groups – United States, 1976–1993. From the Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep 1998; 47:605–609.

72. Ding A. Curbing adolescent smoking: a review of the effectiveness of various policies. Yale J Biol Med 2005; 78: 37–44.

73. Jha P, Chaloupka FJ. The economics of global tobacco control. BMJ 2000; 321: 358–361.

74. Chen V, Forster JL. The long-term effect of local policies to restrict retail sale of tobacco to youth. Nicotine Tob Res 2006; 8: 371–377.

75. Cummings KM, Hyland A, Perla J, Giovino GA. Is the prevalence of youth smoking affected by efforts to increase retailer compliance with a minors‘ access law? Nicotine Tob Res 2003; 5: 465–471.

76. Jason LA, Ji PY, Anes MD, Birkhead SH. Active enforcement of cigarette control laws in the prevention of cigarette sales to minors. JAMA 1991; 266: 3159–3161.

77. Goodman PG, Haw S, Kabir Z, Clancy L. Are there health benefits associated with comprehensive smoke-free laws. Int J Public Health 2009; 54: 367–378.

78. Lightwood JM, Glantz SA. Declines in acute myocardial infarction after smoke-free laws and individual risk attributable to secondhand smoke. Circulation 2009; 120: 1373–1379.

79. Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev 2010; 4: CD005992.

80. Hammond D. Health warning messages on tobacco products: a review. Tob Control 2011; 20: 327–337.

81. Hitchman SC, Mons U, Nagelhout GE et al. Effectiveness of the European Union text-only cigarette health warnings: findings from four countries. Eur J Public Health 2011; 22: 693–699.

82. Sambrook Research International. A review of the science base to support the development of health warnings for tobacco packages. 2009.. [on-line] http://ec.europa.eu/health/tobacco/docs/warnings_report_en.pdf

83. Hammond D, Fong GT, McDonald PW, Cameron R, Brown KS. Impact of the graphic Canadian warning labels on adult smoking behaviour. Tob Control 2003; 12: 391–395.

84. Hammond D, Fong GT, McNeill A, Borland R, Cummings KM. Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control 2006; 15: (Suppl 3): iii19–iii25.

85. Hammond D, Fong GT, McDonald PW, Brown KS, Cameron R. Showing leads to doing: graphic cigarette warning labels are an effective public health policy. Eur J Public Health 2006; 16: 223–224.

86. White V, Webster B, Wakefield M. Do graphic health warning labels have an impact on adolescents‘ smoking-related beliefs and behaviours? Addiction 2008; 103: 1562–1571.

87. Lovato C, Linn G, Stead LF, Best A. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. Cochrane Database Syst Rev 2003; (4): CD003439.

88. Saffer H, Chaloupka F. The effect of tobacco advertising bans on tobacco consumption. J Health Econ 2000; 19: 1117–1137.

89. McVey D, Stapleton J. Can anti-smoking television advertising affect smoking behaviour? Controlled trial of the Health Education Authority for England‘s anti-smoking TV campaign. Tob Control 2000; 9: 273–282.

90. Siegel M, Biener L. The impact of an antismoking media campaign on progression to established smoking: results of a longitudinal youth study. Am J Public Health 2000; 90: 380–386.

91. Bala M, Strzeszynski L, Cahill K. Mass media interventions for smoking cessation in adults. Cochrane Database Syst Rev 2008; (1): 1–65.

92. Thomas R. School-based programmes for preventing smoking. Cochrane Database Syst Rev 2002; (4): CD001293.

93. Wiehe SE, Garrison MM, Christakis DA, Ebel BE, Rivara FP. A systematic review of school--based smoking prevention trials with long-term follow-up. J Adolesc Health 2005; 36: 162–169.

94. Fichtenberg CM, Glantz SA. Effect of smoke--free workplaces on smoking behaviour: systematic review. BMJ 2002; 325: 188.

95. Hopkins DP, Razi S, Leeks KD et al. Smokefree policies to reduce tobacco use. A systematic review. Am J Prev Med 2010; 38: (Suppl 2): S275–S289.

96. Office of Tobacco Control. Smoke-free workplaces in Ireland. A one-year review. 2005. [on-line] http://www.dhsspsni.gov.uk/smoke-free.pdf

97. Binkin N, Perra A, Aprile V et al. Effects of a generalised ban on smoking in bars and restaurants, Italy. Int J Tuberc Lung Dis 2007; 11: 522–527.

98. Scollo M, Lal A, Hyland A, Glantz S. Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry. Tob Control 2003; 12: 13–20.

99. Healy GN, Dunstan DW, Salmon J et al. Breaks in sedentary time: beneficial associations with metabolic risk. Diabetes Care 2008; 31: 661–666.

100. O‘Donovan G, Blazevich AJ, Boreham C et al. The ABC of Physical Activity for Health: a consensus statement from the British Association of Sport and Exercise Sciences. J Sports Sci 2010; 28: 573–591.

101. Roux L, Pratt M, Tengs TO et al. Cost effectiveness of community-based physical activity interventions. Am J Prev Med 2008; 35: 578–588.

102. Reiner Z, Sonicki Z, Tedeschi-Reiner E. Public perceptions of cardiovascular risk factors in Croatia: the PERCRO survey. Prev Med 2010; 51: 494–496.

103. Kahn EB, Ramsey LT, Brownson RC et al. The effectiveness of interventions to increase physical activity. A systematic review. Am J Prev Med 2002; 22: (Suppl 4): 73–107.

104. Yang L, Sahlqvist S, McMinn A, Griffin SJ, Ogilvie D. Interventions to promote cycling: systematic review. BMJ 2010; 341: c5293.

105. National Institute for Health and Clinical Excellence. NICE public health guidance 8. Promoting and creating built or natural environments that encourage and support physical activity. 2008. [on-line] http://www.teespublichealth.nhs.uk/document.aspx?id=5884&siteID=1012

106. National Institute for Health and Clinical Excellence. NICE public health guidance 13. Workplace health promotion: how to encourage employees to be physically active. 2008. [on-line] http://www.nice.org.uk/nicemedia/live/11981/40672/40672.pdf

107. National Institute for Health and Clinical Excellence. NICE public health guidance 17.Promoting physical activity, active play and sport of pre-school and school-age children and young people in family, pre-school, school and community settings. 2009. [on-line] http://guidance.nice.org.uk/PH17/Guidance/pdf/English

108. Baker PR, Francis DP, Soares J, Weightman AL, Foster C. Community wide interventions for increasing physical activity. Cochrane Database Syst Rev 2011; (4): CD008366.

109. World Health Organization. Global recommendations on physical activity for health. 2010. [on-line] http://libdoc.who.int/publications/2010/

110. Meyer P, Kayser B, Kossovsky MP et al. Stairs instead of elevators at workplace: cardioprotective effects of a pragmatic intervention. Eur J Cardiovasc Prev Rehabil 2010; 17: 569–575.

111. Shape Europe. 2011. [on-line] http://www.shapeupeurope.net/index.php?page=home

112. World Health Organization. Global Health Risk: Mortality and burden of disease attributable to selected major risks. 2009. [on-line] http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf

113. Directorate-General for Health & Consumers. First progress report on the implementation of the EU alcohol strategy. 2009. [on-line] http://ec.europa.eu/health/archive/ph_determinants/life_style/alcohol/documents/alcohol_progress.pdf

114. Wagenaar AC, Salois MJ, Komro KA. Effects of beverage alcohol price and tax levels on drinking: a meta-analysis of 1003 estimates from 112 studies. Addiction 2009; 104: 179–190.

115. National Institute for Health and Clinical Excellence. NICE public health guidance 24. Alcohol-use disorders: preventing the development of hazardous and harmful drinking. 2010. [on-line] http://guidance.nice.org.uk/PH24/Guidance/pdf/English

116. Anderson P Global alcohol policy and the alcohol industry. Curr Opin Psychiatry 2009; 22: 253–257.

117. Wagenaar AC, Toomey TL. Alcohol policy: gaps between legislative action and current research. Contemporay Drug Problems 2000; 27: 681–733.

118. Mann RE, Macdonald S, Stoduto LG et al. The effects of introducing or lowering legal per se blood alcohol limits for driving: an international review. Accid Anal Prev 2001; 33: 569–583.

119. Shults RA, Elder RW, Sleet DA et al. Reviews of evidence regarding interventions to reduce alcohol-impaired driving. Am J Prev Med 2001; 21: (Suppl 4): 66–88.

120. Her M, Giesbrecht N, Room R, Rehm J. Privatizing alcohol sales and alcohol consumption: evidence and implications. Addiction 1999; 94: 1125–1139.

121. Stockwell T. A review of research into the impacts of alcohol warning labels on attitudes and behaviour. Center for Addiction Research of BC, University of Victoria, British Colombia, Canada, 2006: 1–10.

122. Capewell S, Graham H. Will cardiovascular disease prevention widen health inequalities? PLoS Med 2010; 7: e1000320.

123. Thaler RH, Sunstein CR. Nudge. Improving decisions about health, wealth, and happiness. Penquin Books Ltd 2009: 320 s.

124. WHO/HPR/HEP/95.1, editor. Ottawa Charter for Health Promotion. First International Conference on Health Promotion. 86 Nov 21; Ottawa: 1986. [on-line] http://www.educacion.gob.es/dctm/ministerio/educacion/universidades/educacion-superior-universitaria/universidades-saludables/ottawacharterhp.pdf?documentId=0901e72b81238072

125. Brownell KD, Warner KE. The perils of ignoring history: Big Tobacco played dirty and millions died. How similar is Big Food? Milbank Q 2009; 87: 259–294.

126. Wiist WH. The bottom line or public health. Tactics corporations use to influence health and health policy, and what we can do to counter them. Oxford: Oxford University Press 2010: 592 s.

127. Marteau TM, Ogilvie D, Roland M, Suhrcke M, Kelly MP. Judging nudging: can nudging improve population health? BMJ 2011; 342: d228.

128. World Health Organization. Air Quality Guidelines. Global Update 2005. [on-line] http://www.euro.who.int/__data/assets/pdf_file/0005/78638/E90038.pdf

129. European Commission Environment. 2011. [on-line] http://ec.europa.eu/environment/index_en.html

130. European Commission. EU focus on clear air. 1999. [on-line] http://ec.europa.eu/environment/air/pdf/clean_air.pdf

131. Matthijsen J, Jimmink BA, de Leeuw FA, Smeets WL. BOP Report. Attainability of PM2.5 air quality standards, situation for the Netherlands in a European context. 2009: 50s.

132. Anenberg SC, Horowitz LW, Tong DQ, West JJ. An estimate of the global burden of anthropogenic ozone and fine particulate matter on premature human mortality using atmospheric modeling. Environ Health Perspect 2010; 118: 1189–1195.

133. Steele BN, Draney MT, Ku JP, Taylor CA. Internet-based system for simulation-based medical planning for cardiovascular disease. IEEE Trans Inf Technol Biomed 2003; 7: 123–129.

134. Marmot M. Fair Society, Healthy Lives. The Marmot Review. Executive Summary. 2011. Strategic Review of Health Inequalities in England post-2010. [on-line] http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review

135. Theorell T, Kristensen TS, Kornitzer M et al. Stress and cardiovascular disease. Vicki J.Roberts-Gassier BB, editor. 2006: 1–35.

136. Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium. Soc Sci Med 2000; 51: 843–857.

137. Chronic Disease Alliance. A unified prevention approach. 2010. [on-line] http://www.idf.org/sites/default/files/Chronic-disease-alliance-Final.pdf

138. Capewell S, Ford ES, Croft JB et al. Cardiovascular risk factor trends and potential for reducing coronary heart disease mortality in the United States of America. Bull World Health Organ 2010; 88: 120–130.

139. Yusuf S, Pais P, Afzal R et al. Effects of a polypill (Polycap) on risk factors in middle-aged individuals without cardiovascular disease (TIPS): a phase II, double-blind, randomised trial. Lancet 2009; 373: 1341–1351.

140. Dabhadkar KC, Kulshreshtha A, Ali MK, Naravan KM. Prospects for a cardiovascular disease prevention polypill. Annu Rev Public Health 2011; 32: 23–38.

141. Malekzadeh F, Marshall T, Pourshams A et al. A pilot double-blind randomised placebo--controlled trial of the effects of fixed-dose combination therapy (“polypill”) on cardiovascular risk factors. Int J Clin Pract 2010; 64: 1220–1227.

142. Rodgers A, Patel A, Berwanger O et al. An international randomised placebo-controlled trial of a four-component combination pill (“polypill”) in people with raised cardiovascular risk. PLoS One 2011; 6: e19857.

143. Cooney MT, Dudina A, Whincup P et al. Re-evaluating the Rose approach: comparative benefits of the population and high-risk preventive strategies. Eur J Cardiovasc Prev Rehabil 2009; 16: 541–549.