148 The World Health Report 2002 Figure 6.1 Case studies of distribution shifting and cardiovascular disease in Finland and Japan Cholesterol distributions and coronary heart disease rates, men 30-59 years of age, North Karelia, Finland, 1972-1992 Distribution of serum cholesterol level Mortality from coronary heart disease 1992 4567891014公88图§ Serum cholesterol (mmol/ Source: National Public Health Institute, Helsinki, Finland. Blood pressure distributions and stroke rates, men 60-69 years of age, Japan, 1965-1995 stribution of systolic blood pressur 000 995 400 100 m册11份1m份222含§图的§国象国§图 Systolic blood pressure(mmHg Source: National Nutrition Survey, Japan. DISTAL OR PROXIMAL RISKS TO HEALTH Although most epidemiological research and intervention analysis has focused on the more immediate risks for major diseases, tackling distal risks to health such as education and poverty can yield fundamental and sustained improvements to future health status Enough is known about the predominant role of distal factors on health and survival to justify vastly greater efforts to reduce poverty and improve access to education, especially for girls. There is huge potential for major health gains through sustained intersectoral action involving other ministries and agencies concerned with development. PRIMARY OR SECONDARY PREVENTION? Risk reduction through primary prevention, such as immunization, is clearly preferable as this actually lowers future exposures and hence the incidence of new disease episodes over time. For long-term health gains it is usually preferable to remove the underlying risk148 The World Health Report 2002 DISTAL OR PROXIMAL RISKS TO HEALTH? Although most epidemiological research and intervention analysis has focused on the more immediate risks for major diseases, tackling distal risks to health such as education and poverty can yield fundamental and sustained improvements to future health status. Enough is known about the predominant role of distal factors on health and survival to justify vastly greater efforts to reduce poverty and improve access to education, especially for girls. There is huge potential for major health gains through sustained intersectoral action involving other ministries and agencies concerned with development. PRIMARY OR SECONDARY PREVENTION? Risk reduction through primary prevention, such as immunization, is clearly preferable as this actually lowers future exposures and hence the incidence of new disease episodes over time. For long-term health gains it is usually preferable to remove the underlying risk. Cholesterol distributions and coronary heart disease rates, men 30–59 years of age, North Karelia, Finland,1972–1992 Distribution of serum cholesterol level Mortality from coronary heart disease Source: National Public Health Institute, Helsinki, Finland. Blood pressure distributions and stroke rates, men 60–69 years of age, Japan, 1965–1995 Distribution of systolic blood pressure Mortality from stroke Source: National Nutrition Survey, Japan. 0 5 10 15 20 25 30 35 40 <90 90- 99 100- 109 110- 119 120- 129 130- 139 140- 149 150- 159 160- 169 170- 179 180- 189 190- 199 200- 209 210- 219 220- 229 230- 239 Systolic blood pressure (mmHg) Population (%) 0 100 200 300 400 500 600 700 800 900 1000 1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 Year Annual mortality rate per 100 000 0 5 10 15 20 25 2 3 4 5 6 7 8 9 10 11 Serum cholesterol (mmol/l) Population (%) 1965 1975 1985 1995 1972 1977 1982 1987 1992 0 200 400 600 100 300 500 700 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 Year Annual mortality rate per 100 000 Figure 6.1 Case studies of distribution shifting and cardiovascular disease in Finland and Japan