The Community Interventions for Health project (CIH) is the action arm of the Oxford Health Alliance and is designed to show-case community approaches to reducing the three main risk factors for non-communicable disease (NCD), namely tobacco use, unhealthy diet and physical inactivity at the population level.
NCD includes cardiovascular disease, cancer, diabetes and chronic respiratory diseases and accounted for over 60% of deaths in 2008, with more than 80% of these occurring in low and middle-income countries (LMIC). Approximately 30% of the deaths in LMIC occur prematurely and are largely preventable. Organisations such as the World Health Organisation (WHO), the United Nations (UN) and the NCD alliance have all recommended evidence-based approaches for lifestyle strategies to reduce and prevent NCD, but little of the available evidence addresses the community or population approach. The population approach includes factors such as health education, structural environmental change, engagement of health providers, transport and education ministries, policy and legislative initiatives and partnerships and coalitions with community organisations. This approach is now recommended by the WHO, and is the strategy adopted by CIH.
CIH is an international collaborative study that took place between 2008-2011 in communities in China, India and Mexico and was designed to reduce the risk of NCD by targeting the three main risk factors of tobacco use, physical inactivity and unhealthy diet. The aim of CIH was to formulate, implement and evaluate culturally sensitive strategies to:
• decrease the prevalence of smoking and smokeless tobacco use
• improve diet by increasing intake of fruit and vegetables and reducing use of salt
• increase levels of physical activity in local communities.
See below for a short video introducing CIH
Study design and methods
CIH had a non-randomised, controlled, before and after quasi-experimental evaluation design and took place in three sites in:
- Hangzhou city, China
- Kerala state, India
- Mexico city
Each country site identified intervention and control areas with a population size between 150,000 and 200,000 people within selected communities and with similar demographic and socioeconomic characteristics. A community was defined as an administrative unit specific to the country setting e.g. delegacion in Mexico and panchayat in India. CIH was conducted in four main settings; health centres, workplaces, schools and the community at large.
For more information about the methodology:
CIH took place in Hangzhou City in China. Hangzhou is located on the Yangtze river delta and is the capital of Zhejiang province in Eastern China. The population of the city in 2010 was estimated at 8.7 million people. Within the city, Xiacheng and Gongshu Districts acted as the intervention sites and Xihu District as the control site.
|Professor Liming Li is the Principal Investigator for CIH China and is the Vice President of the Chinese Academy of Medical Science at Peking University and the founder of the Chinese Center for Disease Control and Prevention.|
|Dr Jun Lv is Study Co-ordinator for CIH China and is an epidemiologist and associate professor in the School of Public Health at Peking University Health Sciences Centre.|
|Siyan Zhan is an epidemiologist at the School of Public Health at Peking University Health Sciences Centre and is a member of the CIH China team.|
|Dr Quingmin Liu is Deputy Chief Physician and director of the Chinese Center for Disease Control and Prevention.|
CIH in India took place in Kerala state. Kerala is located on the south west coast of India, next to the Indian ocean, and covers an area of 38,863 km2 (15,005 sq mi). The population of Kerala was estimated at 33.4 million in 2011. CIH in India was designed as a delayed intervention study in response to the demands of the local Ethic Committee, where Athiyannur acted as the intervention area and Chirayinkeezhu as the control area during the course of the study. At the end of the study period, once all follow-up evaluation was completed, the interventions were introduced in Chirayinkeezhu.
|Professor KR Thankappan is the Principal Investigator for CIH India. He is professor and head of the Achutha Menon Centre for Health Science Studies at the Sree Chitra Tirunal Institute for Medical Sciences and Technology in Trivandrum, which hosted India’s first Master of Public Health (MPH) program.|
|Profoessor S Sivasankram is the Co-Principal Investigator and is Professor of Cardiology at the Sree Chitra Tirunal Institute for Medical Sciences and Technology with a strong interest in paediatric cardiology.|
|Dr Ravi Prasad Varma is the project co-ordinator for CIH India and is based at the Sree Chitra Tirunal Institute for Medical Sciences and Technology.|
|NS Rajeev specialises in community health and is taking the lead on workplaces in CIH India.|
The Mexico site for CIH was in Mexico City. Mexico City is the largest city in Mexico and is the seat of the Federal Powers of the Mexican Union. The city is situated in the centre of the country and the estimated population of Mexico City in 2012 was 8.8 million. The CIH study took place in two urban areas in the city, with Tlaplan as the intervention area and Xochimilco as the intervention area.
|Dr Beatriz Champagne is Executive Director of the InterAmerican Heart Foundation, a non-governmental organisation dedicated to reducing the burden of cardiovascular disease in Latin American and the Caribbean and has a particular interest in tobacco cessation. She acts as advisor to CIH Mexico.|
|Dr Jorge A Ramírez is the Principal investigator in Mexico and is a senior lecturer at the Faculty of Medicine at the National Autonomous University of Mexico (UNAM) and of Anthropology of Health at the National School of Anthropology and History in Mexico.|
|Dr Teresa Fernández is a past Head of Health services at the municipality of Tlalpan and is a lecturer in Social Odontology at UNAM. She has an interst in epidemiology, and has wide experiences in health services administration and intervention projects in community health in Xochimilco and Tlalpan.|
As part of the CIH project, OxHA has produced a manual which provides an overview of interventions that are designed to improve the health of communities by reducing tobacco use, improving diet and increasing physical activity. The manual also provides a background to community interventions for health, explores the evidence base and offers a description of evaluation techniques.
The full background, methodology and results have been published as a monograph
Please click here to download