Where needs and demands diverge: health promotion in primary care

This study reviews Forth Valley Health Board's 'Be Better Hearted' coronary heart disease health promotion programme by analysis of data routinely collected between 1988 and 1993. Associations between socioeconomic deprivation, prevalence of risk factors, and attendance at health promotion clinics are of particular interest in relation to future health promotion strategy.

A study was made of computerised records of 20,053 baseline risk factor assessments in the primary care setting and 1,058 follow-up attendances. A method of classification by socioeconomic status was applied.

Baseline data provided a profile of new attenders over time with regard to age, gender, risk factors and socioeconomic status but lack of follow-up information prevented evaluation of the outcome of the programme. There was a statistically significant association between prevalence of risk factors (such as smoking, obesity and lack of exercise) and deprivation. In the most affluent areas 19.0% of the target population participated in the programme; in deprived areas this fell to 10.7%. There was thus a failure to involve those most in need of health promotion.

If equity in provision of health promotion is to be achieved, measures must be taken locally and nationally to reach deprived sections of the population. In this type of health promotion programme, baseline and follow-up information should be entered on computer at the clinical locus to enable monitoring of outcome. These conclusions are particularly relevant to the national arrangements for health promotion in primary care which were introduced in July 1993.