Quarterly Bulletin of the European Heart Network

HeartMattersHeartMattersDecember 2001

Starting young for healthy hearts

We have looked at studies and data on

the major lifestyle factors that are pre-

dictors of risk of cardiovascular diseases

(CVD), namely physical inactivity, un-

healthy dietary habits and smoking.

We have discussed policy developments

and recommendations in these areas,

and we have presented a variety of

innovative activities that national heart

foundations and their alliance partners

have engaged in to encourage healthy

lifestyles among young people.

Why, you might ask, are we focusing on

children and young people when we are

talking about preventing CVD? Although

it is true that children and young people

suffer from CVD, only a small number are

affected – so why not focus instead on

the adult population, which is at a much

higher risk for developing CVD?

First of all, we believe that laying the

groundwork for a healthy lifestyle is

probably best done at an early stage

in life. But more importantly, there is

alarming evidence that intervention is

needed. Studies show that inadequate

levels of physical activity married with

fast-food diets high in saturated fat and

sugar fuel the rates of type 2 diabetes

among children; this type of diabetes,

which once was common only in those

over 50 years of age, increases the risk of

heart disease. Research also indicates that

teenagers consuming high-fat diets show

signs of arterial disease that will translate

into strokes and heart attacks later in life.

In fact, evidence of heart disease can be

seen on ultrasound examination of these

teenagers. When the take-up of tobacco

use among adolescents is added to the

mix, there is a considerable risk that we’ll

have a high percentage of the future

adult population walking around with a

heart attack waiting to happen.

Therefore it is essential that we do

everything we can to encourage our

young people to embrace healthy

lifestyles.

Meeting the youth challenge

Conveying messages and examples

concerning healthy lifestyles to children

and young people may well be easier

said than done, though. Often experimen-

tation, exploring boundaries and testing

limits dominate the teen years and

authority is not readily accepted.

We are, therefore, not looking at the

same methods of communication as

those effectively used with adults.

We must show young people that we care

and that healthy lifestyles are not boring.

But we must also make sure that we

involve them in decisions that are of

concern to them. To turn young people

into wholesome healthy adults is our

challenge and our responsibility. If we are

successful, even our governments’ finance

ministers might thank us.

editorial

A Heart for Life by Leslie Busk

Chairman, European Heart Network

In the course of 2001, we have examined children’s and young people’s behaviour from a number of different angles

relating to health, and especially to heart health.

HeartMatters

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“ We look forward to a new Community action programmein the field of public health, which will give an impetus tohealth across all policies and to a consolidated pushtowards a societal climate conducive to heart health.”

CHILD

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Other heart issues

The reader must not think that we work

only on topics relating to children and

young people. We have given priority to

these subjects in the four issues of Heart

Matters published in 2001 because they

are significant and because we want

to make our contribution to reduce, as

quickly as possible, the number of people

who die before the age of 65 from heart

disease and stroke.

Of course, healthy lifestyles are equally

important for adults, and age itself

increases the risk of CVD. In 2002, we

expect to report on a range of more

specific issues related to heart health

and the prevention of CVD.

Health on the European Union agenda

The European Heart Health Initiative

(EHHI), which started in 1998 and which

is partially funded by the European

Commission, has provided a tremendous

opportunity for all those actively involved

– including heart foundations, other

health organisations, experts in various

areas and health professionals – to learn

more about each other’s activities,

experiences and knowledge. We have

also seen that during the same period

health has taken a much more prominent

place on the European Union’s agenda,

and we would like to think that the

European Heart Network, its members

and its alliance partners at all levels

can take some credit for that.

The European Union does not have a

strong competence in health and this is

wrong, because many of the policy areas

for which it does have responsibility have

a direct impact on the behaviour of its

citizens and therefore on their health.

We look forward to a new Community

action programme in the field of public

health, which will give an impetus to

health across all policies and to a

consolidated push towards a societal

climate conducive to heart health.

Ultimately, we would welcome a Treaty

provision that would allow the European

Union to harmonise legislation on public

health grounds, simply to avoid situations

where measures needed to protect

public health may otherwise be

jeopardised.

HeartMatters

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1 EditorialA heart for life

3 Feature articlesYoung@heart

8 Country activities

DenmarkFinlandGermanyIrelandItalySpainThe NetherlandsTurkeyUnited Kingdom

19 Contact information

Heart Matters, focusing on cardiovasculardisease prevention, is a quarterly publication relevant to policy makers, public health experts and organisationsinvolved in health promotion, diseaseprevention and public health research.

2

Heart disease is the United Kingdom's

biggest single killer. Every year 140,000

people die from coronary heart disease

(CHD), 20,000 of them before they reach

the age of 65. Currently in the UK there

are 106,000 people under the age of 65

who have had a heart attack1.

Risk can be reduced significantly

As we know, heart disease is largely

preventable – there is good evidence

to suggest that at least 75% of new cases

of CHD can be explained by the major

risk factors of poor diet, physical inactivity

and tobacco use2. In developed countries

like the UK, about 95% of the adult

population has some risk of CHD. Since

CHD manifests itself in adulthood,

prevention strategies have focused on

modifying adult behaviours, and targeted

prevention efforts in adults in the UK have

been successful in reducing disease rates

in recent decades. Indeed, based on

current trends the UK government's target,

a 40% reduction in deaths from cardio-

vascular disease in people under the age

of 75 by 2010, will easily be reached3.

However, there is an established body of

evidence to show that the development

of CHD starts early in life and continues

throughout the life course4. Foetal under-

nutrition and exposure to tobacco

products via the placenta increase

susceptibility to later disease. Lifetime

dietary habits tend to be laid down in

childhood, and atherosclerotic lesions

have been found in the arteries of

children as young as nine years old.

Physical activity in childhood is important

for weight control. Most smokers take

up the habit before the age of 18

and people who have not started to

smoke by the age of 20 are unlikely

ever to do so.

Child poverty is also a major factor,

with a strong correlation between

deprivation and risk of coronary heart

disease. Over the last 30 years in the UK,

growing inequalities have been closely

mirrored by a widening social class gulf in

coronary heart disease, with the poorest

members of society now suffering a more

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HeartMatters

Young@heartby Louise Sarch, National Heart Forum, UK

Young@heart is the major new initiative of the National Heart Forum (NHF) in the United Kingdom. It embraces the

declaration made at the Brussels Winning Hearts conference on 14 February 2001 as its aim: every child should be able

to live to at least the age of 65 free from avoidable heart disease.

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than two-fold greater risk than those who

are better off5. One in three children in

the UK grows up in relative poverty; this

proportion is higher than in any other EU

Member State6.

More work needed with young people

Given this knowledge, it is frightening that

little is being done to promote the heart

health of children and young people.

Indeed, rates of teenage smoking appear

to be increasing, particularly amongst

young women. The diets of children and

young people are nutritionally poor

compared to thirty years ago – they

increasingly eat too many fatty, sugary

and salty foods and too little fruit and

vegetables. Youngsters also do not take

enough physical activity7.

So far in the UK these risk factors in

childhood are not being adequately

tackled, even though if current knowledge

about the causes and prevention of heart

disease were turned into effective policy

action focusing on children and young

people, death and disability from coronary

heart disease among people under 65

could be practically eliminated.

The NHF’s young@heart policy framework

of recommendations sets out a blueprint

for UK-wide action for the heart health

of children and young people. Its key

goal is for governments across the UK to

demonstrate strong, visible and sustained

leadership by establishing children and

young people's health and wellbeing

units in England, Scotland, Wales and

Northern Ireland to implement and

develop national child health plans.

These units should be coordinated by

a central UK unit located at the heart of

the government, in the Cabinet Office.

The young@heart policy framework is

comprised of three core comprehensive

strategies on nutrition, physical activity

and smoking; in addition it complements

and strengthens policies to eradicate

child poverty. Particular emphasis is placed

on involving children and young people in

local and national decision making, to

ensure that the environments in which

they live, study and play are appropriate

to their needs.

Young@heart: starting up

The NHF, an alliance of over 40 UK

organisations concerned with heart

disease prevention, embarked on the

young@heart initiative following the

European Heart Network's (EHN) Winning

Hearts conference in February 2000.

The NHF, a member of the EHN, has been

closely involved with the EHN's European

Commission-sponsored European Heart

Health Initiative (EHHI), a project set up

in 1998 to build networks of organisations

involved with heart disease prevention in

each Member State, to raise awareness

of heart disease prevention and to make it

a priority for the EU and its Member States.

In the first phase of the EHHI the members

of the EHN involved in the EHHI sought to

set up networks and raise awareness

through a series of activities based on the

theme of children. This work culminated in

the Winning Hearts declaration.

HeartMatters

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1 British Heart Foundation HealthPromotion Unit. Coronary heartdisease statistics: Morbiditysupplements. British Heart FoundationStatistics Database 2001. London:British Heart Foundation, 2001.

2 Beaglehole, R. ‘Global cardiovasculardisease prevention: time to getserious.’ The Lancet 2001; 358: 661-663.

3 British Heart Foundation HealthPromotion Unit. Coronary heartdisease statistics: British HeartFoundation Statistics Database 2000.London: British Heart Foundation,2000.

4 Kuh, D. & Ben-Shlomo, Y. A life courseapproach to chronic diseaseepidemiology. Oxford: OxfordMedical Publications, 1997.

5 Office for National Statistics. HealthInequalities. London: The StationaryOffice, 1997.

6 UNICEF. A league table of childpoverty in rich nations. Innocentireport card 2000; 14.

7 Department of Health. Health Survey for England: The health of youngpeople 1995-1997. London: TheStationary Office, 1997.

“ In developed countries like the UK, about 95% of the adultpopulation has some risk of coronary heart disease.”

As a signatory to the declaration and

committed to making it a reality, the

NHF wanted to take this forward in the

UK and therefore created young@heart,

with support from the British Heart

Foundation, the Health Development

Agency and the Nuffield Trust.

Forming policy recommendations

The first phase of young@heart, a life

course approach to the prevention of

heart disease starting in childhood, was

made up of three strands:

• A review of evidence to assess the

potential for reducing coronary risk from

early life and through interventions in

childhood;

• Consultation with experts to develop

recommendations on policies and

actions at national and local level to

tackle the origins of coronary heart

disease in early life;

• Exploring children’s views to find out

what children think about their health

and influences on their health.

As the first strand, the most recent

comprehensive review of evidence

on risk factors and determinants

that influence children’s health was

commissioned by the NHF especially

for young@heart. The review looked at

physical activity, diet and body weight,

smoking behaviour, development in

the womb and other physiological

measurements. Papers commissioned

from experts in epidemiology and

children’s behaviour provided the basis

for an analytical review of the current

evidence and recommendations for

action.

In parallel, a policy group made up

of public affairs experts from multi-

disciplinary backgrounds was charged

with developing a policy framework of

policy proposals and recommendations,

including actions at local and national

level, to tackle the origins of coronary

heart disease in childhood. The policy

group drew on the results of the research

review and an audit of current UK policy

initiatives which have an impact on child

health.

They developed tangible and practicable

recommendations based on the evidence

which would link current policies, fill gaps,

eliminate inconsistencies and suggest

new, more effective policy actions or

initiatives.

To ensure that the young@heart initiative

took proper account of the practical

experience of children’s daily lives, the

NHF commissioned a new review of studies

that have looked at children’s behaviour,

attitudes and opinions. A video-recorded

talkshop with thirty invited 11 to 17-year-

olds was also held to explore the findings

of the review, which relate to children’s

health and wellbeing and to some of the

broader social, environmental and

economic health determinants.

This first phase of young@heart culminated

in a policy summit meeting in June 2001.

Over 90 opinion formers and experts from

multidisciplinary fields were invited to

rigorously appraise the draft policy

framework of recommendations and

discuss how to achieve the young@heart

aim that every child born in the UK should

be able to live to at least the age of 65

free of avoidable heart disease.

Declaration

Made at the conference "Winning

Hearts" – Actions and Policies for a

Healthier Europe

The signatories of this Declaration ask the

European Commission and all European

and national policy-makers to share a

common vision, namely that:

HeartMatters

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“ Every child born in the new millennium has the right to liveuntil the age of at least 65 without suffering from avoidablecardiovascular disease.”

HeartMatters

“ There is good evidence to suggest that at least 75% ofnew cases of cardiovascular disease can be explained bythe major risk factors of poor diet, physical inactivity and tobacco use.”

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Following the summit, a policy statement

was issued that calls for:

• governments across the UK to demon-

strate strong, visible and sustained

leadership by establishing children and

young people’s health and wellbeing

units in England, Scotland, Wales and

Northern Ireland to develop national

child health plans;

• plans to contain comprehensive

strategies, with targets, to improve

children and young people’s nutrition

and physical activity levels and to tackle

smoking. These should be established

without delay and form the key planks

of the plan;

• views of children and young people to

inform the development of the plan;

• current investment to be maintained,

if not increased, for family and child

anti-poverty policies;

• more research to develop anti-poverty

policies and comprehensive anti-

smoking strategies. These should be

targeted at children and young people

and complement adult campaigns and

programmes.

Since the summit meeting the NHF has

updated, revised and restructured the

policy framework in the light of discussion

and has now sent it out for consultation

to over 200 people, including all our

members and those involved in

young@heart. As we wait for the results

of the consultation we have embarked

on the second phase of young@heart.

Implementing the policy framework

The second phase of young@heart is to

advocate and implement the policy

framework of recommendations across

the UK. In order to help us do this we have

invited senior media professionals and

politicians, health and policy experts,

and opinion formers to advise us. We

have devised a comprehensive advocacy

and communications strategy which we

will roll out following the launch of the

young@heart final policy framework at

the Houses of Parliament on 14 February

2002, the second anniversary

of Winning Hearts.

For further information visit

www.heartforum.org.uk/young, where

we have developed a dedicated web

site to support continuing consultation

on the policy framework, or contact us

by e-mail at young@heartforum.org.uk.

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HeartMatters

“ If current knowledge about the causes and prevention of heart disease were turned into effective policy actionfocusing on children and young people, death anddisability from coronary heart disease among peopleunder 65 could be practically eliminated.”

Lack of physical activity and exercisesignificantly increases the risk of cardio-vascular diseases. A study supported bythe Danish Heart Foundation demonstratesthat nine-year-old children who are mainlyinactive have a risk of developing riskfactors for cardiovascular diseases sixtimes higher than children in goodphysical health. This is an incentive to the Danish Heart Foundation to supportinitiatives that stimulate and foster exercise among children.

Good work of Christmas Seal Homesrecognised

“The Fitness Profile of the Year” is a titlethat the four Christmas Seal Homes cancarry with pride. This prize is awarded bythe Danish School Sports association andthe Danish Heart Foundation every year in connection with the Schools’ Day ofExercise to people or organisations whohave contributed with a special effort inrelation to children and exercise.

The Christmas Seal Homes offer abreathing spell away from school andhome as well as a confidence booster forsix hundred obese boys and girls, five tofourteen years old, who live in one of thefour homes every year in order to progressin life after social and psychologicalproblems. The Christmas Seal Homes aimat strengthening the initiative, the creativeurge and the joy of life of these children.This is achieved through fixed frameworks,healthy food and plenty of exercise.Games, exercise and warm companion-ship are important components of theeveryday life of the children in thesehomes. Due to this effort the Danish SchoolSports association and the Danish HeartFoundation quickly agreed to reward theChristmas Seal Homes and the childrenwith a prize.

"The Christmas Seal Homes teach thechildren of the many benefits connectedto exercise. Among other things, exercisestrengthens the body and heart and leadsto an improvement in physical fitness,muscular activity and the ability toconcentrate. In addition, the obesechildren lose some excess weight and

get a smile on their faces," says HansSøndergaard, responsible for exercise in the Danish Heart Foundation.

Children need exercise that is fun to do

"The Christmas Seal Homes make a greateffort in order to teach the children theimportance of finding the kind of exercisewhich they like the most. The essentialthing is that the children find the exerciseenjoyable, and that they have theexperience of becoming more skilful.These things are achieved in an environ-ment where the children are amongfriends who are in similar situations.Additionally, these children experiencenew and exciting things that are importantin order to keep up their interest inexercise.

"Children ought to have at least one hourof exercise every day. Which kind ofexercise they choose is of less importance.A walk or a cycling tour, ball games, skateboarding, riding on a scooter, dancing,gymnastics, climbing trees or whateverthey prefer – only their imaginations limitthe possibilities of fun exercise. First andforemost, enthusiasm, confidence andfantasy are to be released among thechildren, and this is where the ChristmasSeal Homes make an importantdifference. The children experience therevelation that exercise can be a naturalpart of everyday life, and that theopportunities for expression of the bodycan compete with the television or thecomputer," Hans Søndergaard explains.

News from Denmarkby the Danish Heart Foundation

Exercise brings a better life and better health to obese children

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A number of different activities aimed at children are being operated by theFinnish Heart Association, working alone or together with other organisations.Included as well here is a brief report onthe activities of an allied association, Young Finland.

Children's Health Forum

In 1999 the Finnish Heart Association (FHA)invited several partners active in the fieldof child and youth welfare to discuss theidea of developing collaborative work. As a result a number of concernedorganisations formed the Children's HealthForum. The Forum’s purpose is to increasethe wellbeing of children and youngpeople, using as starting points the basicfactors of daily life in families with children:nutrition, physical activity, rest and joy. Its primary objective is to give support toparents, professional educators, thoseinvolved in health work and others in touchwith children, while keeping the maintarget in mind: children and young peoplethemselves. In addition, the Forum alsotargets decision-makers and otherauthorities to ensure that they are well-informed about key factors and activities.So far the most valuable outcome of theForum has been to offer a platform foropen conversation and the developmentof collaboration.

Organisations taking part in this Children'sHealth Forum are the Finnish HeartAssociation, the Mannerheim League for Child Welfare, the Association ofPulmonary Disabled, the FinnishRheumatism Association, the FinnishCancer Association, Young Finland, the Finnish Centre for Health Promotion,Bianca Morales Productions, the FinnishAsthma and Allergy Association, the HealthAssociation, the Osteoporosis Associationand the Finnish Mental Health Association.

The Forum has produced an informationpack on the alliance members (activities,materials and calendar of events).

The FHA's second workshop “Adults, do you know how the health of Finnish school children is today?” took place in September 2001. The main players of the workshop were the experts on thehealth of schoolchildren – the pupilsthemselves. During the autumn thechildren had a chance to discuss questions on health and relate their views e.g. by writing to a web site openedfor this purpose. Then the data of thewebsite discussions was given to theexperts participating in the consensusmeeting on the health of the school-children in November 2001. From this meeting the experts produced aconsensus statement

Activities for the very young

The next activity peak of the FHA isscheduled to occur in connection withHeart Week 2002. Launched during HeartWeek 2001, the Kids Project targets daycare centres and pre-schools. A leafletand a mini poster on heart-friendly ideasfor eating and moving produced for thechildren to take home and to bedistributed at parents' evenings includerecipes for between-meal snacks andideas for health-enhancing physicalactivities. Additional material for teachersincludes ideas on how they can bring theheart health promotion ideas into theirdaily classroom activities during and afterthe Heart Week. The nursery school

teacher's guide "Heart Matters to NurserySchools" presents basic information abouta heart-friendly diet and suggests adifferent issue for each weekday.

Partners in this project are the YoungFinland Association and the Federation of Nursery School Teachers.

Halt the Salt - Half will Do programme

“Halt the Salt,” targeted at 13 and 14-year-olds, aims to make them conscious of theharmful effects of salt intake. The materialsinclude a teacher's pack, a “Salty Stories”video and a leaflet “Halt the Salt - Half WillDo” (also available in English). Among thediscussion topics in the teacher's pack arethe history, chemistry and physiology ofsalt, salt in foods, low-sodium products,intake of salt and hints for reducing saltintake.

Young Finland: Activities and output

Young Finland is an association that hasoperated since 1987 as the spokesman forencouraging children and young peopleto participate in physical activities. Thework is done with partners interested inphysical activity for children and youngpeople. The purpose is to ensure that everychild has the right to practise some sort ofphysical exercise.

• Active afternoon. The after-schoolproject is intended to reduce thenumber of afternoons 6 to 12-year-oldchildren spend alone and at the sametime to increase daily physical activityamong this age group. The target groupincludes 380,000 primary school childrenwhose inactive and lonely afternoonsare made active and full of playmates.

• Playing kindergarten. The associationshave educated day-care centrepersonnel since the beginning of the1990s, in cooperation with the regionalsports organisations and the sportsinstitutes. At present the playingkindergarten is active in about onehundred localities in different sports clubs and associations.

News from Finlandby the Finnish Heart Association

Action for fit and well-nourished children

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In 1998 the Action Plan for PromotingFinnish Heart Health was formulated. This comprehensive plan includes thestatement that in the long run in theprevention of heart disease childrenand young people are the mostimportant target group.

Accordingly, the Action Plan includesthe following recommendations:

• Maternity care and school healthcare resources must be secured formore developed functioning.

• Financial resources of children's and adolescents' canteen cateringshould be developed to the samelevel as workplace catering, andmeals which comply with nutritionalrecommendations should beserved at day care centres andschools.

• In the national alcohol programme,the emphasis will be on betterrecognition of and respect for the real needs of the young.

• Primary, secondary and tradeschools must promote students’physical, mental and socialwellbeing. The number of physicaleducation classes must beadequate for all age groups.

• It is necessary to ensure thatschools are non-smoking. Theresponsibility of social, health,teaching, youth and part-timeemployees as adult role models is emphasised by promoting a commitment to non-smoking, at least during working hours.

The current situation in Finland inregard to young people is quitealarming: smoking, heavy drinkingand drug experiences have becomemore common. Amongst 15 to 16-year-olds, 24% of the girls and 29% ofthe boys smoke daily, 26% of the girlsand 34% of the boys drink heavily atleast once a month, and as many as15% of girls and boys have alreadytried drugs at least once.

More detailed information aboutFinnish policies concerning nutrition,physical activity and smoking is foundin previous issues of Heart Matters.

HeartMatters 10

The Finnish Heart Association’s action plan promotes heart health on all fronts

• Sports Adventure Around the World:Sports adventure is directed at childrenin the lower grades of comprehensiveschool. The aim of the campaign is topromote daily exercise among children,particularly among those who do notexercise daily. After planning starting in the spring of 2000, in autumn 2000 the campaign was marketed in schoolsand schoolchildren were encouraged to choose a campaign mascot. Severaldifferent sectors, ministries, schools andsports organisations took part in theimplementation of the Sports Adventure.Altogether 1,444 schools and 4,418classes with 93,213 pupils had enrolled by the end of the year 2000.

The programme features web sites for teachers, pupils and parents(www.nuorisuomi.fi/liikuntaseikkailu).Included is a database with tips forphysical activities. Each class sets its own target, e.g. move as much as thedistance from Helsinki to Paris. When the class reaches its target city, the web site of the target opens. In addition, the class receives city and countryinformation and local physical activityhints. Everyone’s participation is requiredfor the adventure to make proper progressin this ongoing programme.

Several activities of the German HeartFoundation focus on helping children with congenital heart disease and theirfamilies. A holiday camp, a doctor-parentsseminar and various sport activitiesprovide information and support tochildren and their families.

A weekend for families and ‘aliens’

In June 2001 the second German HeartFoundation family weekend broughttogether a group of around 100 peoplefrom families with children who areaffected by congenital heart disease at a small ‘holiday village’ in Germany.This long weekend was very successful inspite of continuous rain, as the organisershad numerous indoor games planned.Handicrafts, an opportunity to swim, and a barbecue kept everyone busy for thefirst full day of the programme, while onthe second day a unique game seteveryone solving problems together.Divided into groups, the participants had to help a group of ‘aliens’ from a‘spaceship’ return home, by asking themquestions and working together to solvesome tricky problems. This wonderful game with nothing but winners wasenjoyed by all.

Children benefited from the weekend,making new playmates and confirmingthat they are not alone in dealing with theproblems they face. Their siblings enjoyedthe games and fun as well, and theparents were able to talk with each otherand exchange experiences and helpfulinformation regarding their life withchildren with congenital heart disease.

A seminar for doctors and parents

Under the aegis of the German HeartFoundation, in five different cities inGermany, Berlin, Duisburg, Freiburg,Erlangen and Steinerskirchen, groups of four to seven professors held seminarsfor doctors and parents of children withcongenital heart disease. This year’sseminars, the second in a series,highlighted "Irregular heartbeat withchildren". In addition to a presentation

about the functioning of the heart and thedifferent kinds of irregular heartbeats, theexperts informed an interested audienceabout medical and electrophysiologicalmethods of treatment and about the useof pacemakers.

The aim of these seminars, interesting for both lay people and physicians, is to provide information, but also to giveparents of children with congenital heartdisease more security in dealing with theirchildren’s illness.

In-line skating for fun and health

In Frankfurt the German Heart Foundationis involved in a programme to teach in-lineskating to children with congenital heartdisease. Such children often grow up in avery protected environment, and theirparents are afraid to let them take risks.This project teaches a safer in-line skatingtechnique, with children trained to slowdown and to fall without hurtingthemselves. By participating in this excitingsport, the children can rid themselves ofaggression, anxieties and emotional stress.As they become more fit and skilful, theywill be less likely to be stigmatised andridiculed by classmates, as social rankingamong youngsters is largely determinedby physical fitness.

Each group includes a maximum of 12children aged 8 and up with congenitalheart disease, together with siblings andfriends. For two hours per week theyexercise, play games and participate inhockey. The paediatric cardiologists incharge of the programme ensure that acardiologist is always standing by, but inthe year and one half of the project so far,no emergency has occurred. All thechildren participating are in better healththan at the beginning, with more stamina,and improved self-esteem.

Skiing not just for the hearty

Ordinarily skiing is considered too strenuousfor people with congenital heart disease,but the German Heart Foundation hasproved this wrong with a very successful skitrip in Austria. The third outing of its kindorganised by the foundation, this year theexcursion brought together 22 youngpeople, from 9 to 23 years old, all withcongenital heart disease, for a week in thewintry paradise during March 2001.

Supervision was abundant for the group,with a cardiologist, other physicians andsupervisory personnel monitoring and

helping the children. The young skiers were divided into four groups based on their individual skill levels. Each group was accompanied by two doctors, whomeasured everyone’s blood pressure anddiscussed their individual health status witheach participant. On the second day thephysicians decided to discontinuemeasuring blood pressure as all the datawere correct and no abnormalities weredetected.

The relatively easy technique of carvingskiing was taught to the participants. As itdoes not require a great deal of strength it was considered appropriate, and theyoungsters were very successful. Some ofthem specialised in hand carving or bodycarving, where the skier touches the snowwhile curving. Even participants with verycomplex heart problems successfullypractised this technique, to the surprise of their trainers.

Evening games completed the activities,and the young people thoroughly enjoyedthemselves. The ski week will definitelycontinue as an annual event.

Sailing the seas

In July 2001 a group of 15 youngsters withcongenital heart disease sailed for a weekon a two-mast, 35 m long sailing ship. Twocardiologists, a group leader and a smallcrew completed the group of 21. Amongthe things they learned were sailing skillsand cooperative work with a group livingin close quarters, as they prepared meals,cleaned the decks and managed the shipall the way to Denmark, achieving the aimof sailing rather than depending on theship’s motor.

While the youngsters were learningtraditional sailing and improving their self-esteem, their monitors learned thatyoungsters with heart problems canachieve more in sport activities thanexpected. As the participants were awareof their own limits, they worked as much as they could and stopped when theywere tired, so no use had to be made ofthe medical equipment the group tookalong. The cardiologists made a long-termECG of each participant, without findinganything abnormal.

At the end of the trip, the youngstersentertained their families and friends onboard and displayed their new knowledgeto general acclaim. The German HeartFoundation plans a similar trip for nextyear.

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News from Germanyby the German Heart Foundation

Activities for children living with congenital heart disease

HeartMatters

The National Heart Alliance, establishedduring the first phase of the European HeartHealth Initiative, is an independent non-governmental organisation which aims toincrease co-operation among organisationsinvolved in the fight against heart disease.

In common with our counterparts in otherEU countries, the National Heart Alliance inIreland has been focusing on children andyoung people. The Alliance has concen-trated on advocating for change in theareas of smoking, physical activity andnutrition, rather than on intervention andeducation.

Significant gains toward reducing smokingamongst the young

One third of boys and girls in Ireland areregular smokers by the age of 15 to 17. The National Heart Alliance has beenadvocating changes in the legislationrelating to tobacco and, in a positionpaper published in March 2000, theAlliance called for a number of specificmeasures. These included:• an increase in the legal age of tobacco

sale to 18;• enforcement of legislation on sales to

children;• introduction of licences to sell tobacco; • removal of tobacco from the Consumer

Price Index; • a ban on vending machines selling

tobacco products;• Nicotine Replacement Therapy to be

made available free of charge tosmokers;

• research and development of smokingcessation programmes specifically foryoung people.

Since the publication of this position paper,due to the efforts of a number oforganisations, in particular ASH Ireland,progress has been made in some of theseareas:• An independent Office for Tobacco

Control has been established with theremit to coordinate government policytowards a tobacco-free society.

• The legal age at which a person can besold tobacco products has been raisedto 18 years (1 August 2001) and it is nowillegal to permit the usage of tobaccovending machines by those under 18.

• Nicotine Replacement Therapy hasbecome available free to charge tomedical-card holders (i.e. low incomeearners) on prescription from theirgeneral practitioner from 1 April 2001.

• The Minister for Health Removal hassupported the removal of tobacco fromthe Consumer Price Index.

Proposed future legislation will end all formsof product display and in-store advertisingand will require all retailers to register withthe new Tobacco Control Agency. Packs often cigarettes, whose low cost makes iteasier for children to start smoking despitetheir limited income, will be banned, andenforcement officers will be given thenecessary powers to ensure there is fullcompliance with the law.

Providing better nutrition for children

In the absence of national nutritionalguidelines for children and young people,the National Heart Alliance in conjunctionwith the Irish Heart Foundation Council onNutrition has developed a "Statement onChildhood Nutrition."

The Alliance has been lobbying for theprovision of resources for school lunches so that all school-going children can availthemselves of a healthy school meal eachday. The Alliance has also called forresources to establish breakfast clubs for all children in disadvantaged areas.

In July 2000, the Alliance made a submissionto an interdepartmental School MealsReview Group which was established andchaired by the Department of Social,Community and Family Affairs. The report onthis review of school meals is due to befinalised by the end of 2001. Recommen-dations to be made in this report will bepractical and feasible and will include therecommendation that all disadvantagedschool-children should have access to anutritious free school lunch which will includefruit and/or fruit juice.

In November the Alliance will take part in aconsultative forum on Food and NutritionGuidelines for Schools organised by theDepartments of Health & Children, andFamily, Community & Social Affairs. Thesenutrition guidelines will be produced early in 2002.

The National Heart Alliance Statement onChildhood Nutrition will be published earlyin 2002. This statement will primarily serve asa resource for health professionals.

Encouraging more physical activity

As in other EU countries, during the currentyear the Alliance has been concentratingon physical activity. A position paper onphysical activity for children and youngpeople was published in July 2001 and aconference on “Physical Activity, Creatinga Supportive Environment for Children andYoung People”, was held to coincide withthe publication of the paper.

The position paper illustrates how manyorganisations can play a role in providing a more supportive environment for ourchildren, particularly in terms of a physicalenvironment that makes play and physicalactivity more accessible and enjoyable.The National Heart Alliance aims to showthat the health of our children is not just theresponsibility of the health services but thatthis responsibility runs right through fromparents through education and localgovernment to the health authorities.

… by expanding the possibilities for activeplay

The National Heart Alliance has contributedto opening up the debate on provision ofplay facilities, particularly highlighting theneed for the provision of safe play areasand recreation facilities in disadvantagedareas. The latest figures available show that the ratio of playgrounds to people inIreland is one to 19,098, compared with theratio of one golf course to 10,000 people.

Attendance at the conference on physicalactivity in July 2001 included participantsfrom ten local authorities. A number ofresolutions agreed at this conferencespecifically related to play and recreationfacilities, and included:

• the need for revenue funding to beprovided with capital funding whenfacilities are provided for children’s playand recreation. Lack of maintenanceresources has been cited as is one of themain reasons for the failure of localauthorities to provide such facilities;

• the need for structured training for playand youth leaders/ workers to be madeavailable in Ireland;

• the need for the development ofcommunity partnerships to ensure thatcommunities and schools can sharefacilities and that school facilities belongto the community as a whole. Partnershipmodels are needed and the Departmentof Education should be encouraged torequire facilities in schools to be sharedwith the community.

HeartMatters

News from Irelandby the National Heart Alliance

Progress in several fields for healthy young hearts in Ireland

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Improving physical fitness in Florence

Sli na Slainte, "the path to health", the IrishHeart Foundation’s brainchild, has nowbecome an Italian reality as well. On 28September 2001 in the Palazzo Vecchio inFlorence, the Italian implementation of thishealth promotion concept was officiallylaunched, just in time for World Heart Dayon 30 September. Representatives of thenational and local media, both print andtelevision, heard from the local authoritiesfor health and social care about the threeinitial walking paths constructed in variousareas of Florence.

With EU support, the partnership of the IrishHeart Foundation and additional fundingfrom the County Council of Florence, the authorities have built and marked two4 km paths and one 6 km route. Thousandsof leaflets distributed through schools,museums, fitness centres and leisurecentres are publicising this effort tocontribute to the health of the citizens ofFlorence and the thousands of tourists thatvisit there daily. The paths are marked withthe Sli logo on the sidewalks, and all thegreen areas of Florence are provided withmetallic maps pointing to the locations ofthe three circuits.

Sli na Slainte concentrates on the positivemessage that a 4 km walk every day willcontribute to improved health, withoutany negative warnings that might bereceived with annoyance by the public.Markers spaced at intervals of onekilometre allow walkers to track theirprogress. As the programme makesexercise easy and fun, ALT expects tocontinue supporting it for some time tocome. Other city councils in Italy areconsidering following Florence’s lead, with Sli routes likely soon in Calderara di Reno, Carpi, Sondrio and Sarnico.

Christmas olive oil for better nutrition

ALT is combining a fund-raisingprogramme with encouragement topractise healthy nutrition in a campaigninvolving Christmas baskets with olive oil.ALT supporters living all over Italy, whohave received 15,000 copies of the ALTbulletin promoting this campaign, willencourage their friends, colleagues,neighbours and partners to purchasethese attractive Christmas baskets for theirown use or as inspiring gifts for friends andrelatives. The campaign will also bepromoted through a number of events,ranging from exhibitions to trade fairs tohockey matches.

Included with two bottles of high-qualityUmbria olive oil in the baskets arematerials promoting ALT and explainingCVD risks and ways to improve health, inparticular through the Mediterranean diet,in which olive oil has traditionally playedan important part. The Vini e ApiritiCompany is sponsoring the campaign by contributing packaging and shippingof the baskets.

As the baskets will sell for 20 euros each, ALT hopes to raise some funds from the campaign. More importantly, the organisation hopes that by sellingseveral thousand baskets all over Italy the volunteers can contribute to raising the population’s awareness of thecomponents of a healthy life style.

New magazine to help promote theattractions of not smoking

Thanks to a new magazine to belaunched in December 2001, not smokingwill be linked to glamour and excitement.The project manager of Cuore 2000, Dr Gianluigi Pagano, will present the firstissue of the magazine at a congress on"Young and new lifestyles", at the BolognaMotor Show, one of the largest car andmotorbike trade fairs. Among thehonoured guests who have alreadyconfirmed their attendance is the formerMinister of Public Health, Prof. Umberto

Veronesi. Ms Clarissa Burt will represent the Miss Universe Organisation, a majorsponsor of this initiative. Prof. Mangiaracina,president of SITAB, the Italian society forthe prevention of tobacco consumption,will join Ms Burt in discussing healthylifestyles for better living and for theprevention of heart disease.

The new magazine will primarily targetphysicians and other specialists in thepublic health field. A useful communica-tion tool, it will disseminate a variety ofinformation on smoking prevention. From aprofessional perspective it will analyse theburden of smoking among the Italian andEuropean populations, reporting on data,statistics, campaigns, research, initiativesand reports at national and internationallevels.

Miss Universe Organisation authorities willcooperate in the campaign for freedomfrom smoking, urging all the Italian finalistsin the beauty competition to pledge toremain smoke free. At several meetingsattended by beauty contest finalists,especially in schools, contestants willpromote healthy lifestyles. The winner will also be elected the ‘ambassador’ of a smoke-free universe.

Numerous initiatives like the Miss Universecampaign are expected to be sparked bythis informative magazine.

News from Italyby the Associazione per la Lotta alla Trombosi - ALT (Association for the Fight against Thrombosis)

Heart disease attacked on many fronts in Italy

HeartMatters

13

During the last week of October, theSpanish Heart Foundation carried outseveral activities aimed at young people,in the framework of the XVII Spanish HeartWeek, which was specially dedicated tochildren and teenagers this year.

Approaching schools

In a large covered area set up in thehistoric centre of Madrid, stands withinformation for example on healthynutrition, physical activity, and thefunction of the heart taught children howto carry on a healthy life daily in an easyand comprehensible way. Visits wereagreed with schools, and groups of 30pupils accompanied by their teacherscontinuously made the cardio-healthycircuit.

To appeal to the children, there wereparticipatory activities besides thetheoretical information, such as makingtheir own bread with a baker, drawingtheir heart, or learning through practicalinteractive modules on loan from animportant science museum. Childrencould feel their heart beating by touchingit with their hand and listen to the sound oftheir own heartbeats, or pump out a liquidfrom one ventricle to the other, trying tomaintain the rhythm of the heart beat,and so on.

The Spanish Heart Foundation providedinformation to teachers to continue thelearning process. These visits were very wellreceived by the children, who enjoyedthemselves, and the participating schoolsand teachers acknowledged that itreinforces the classes given at schools inthis area. Due to limited official support,we have found that working directly withschools is a good partnership, both forschools and for the Spanish HeartFoundation.

More than 1,000 children took part in ouractivities during the Week.

Healthy examples for youngsters

The book "The Healthy Life" (La VidaSaludable), just published by the SpanishHeart Foundation for children and teen-agers, was given to all visiting children and

teachers. Ten thousand copies will bedistributed through the schools. This 24-page booklet reviews each behaviourthat helps to keep the heart healthy andtherefore to prevent cardiovasculardisease (CVD). Its goal is to develophealthy habits among young people.

From this book children and adolescentswill learn about the influence of abalanced diet on their health in generaland their hearts in particular; why theregular practice of physical activity isbasic for the correct functioning of theircardiovascular system and for fitness; howeasy avoiding sedentary lifestyles is; whyand how to say "no" to tobacco, drugsand alcohol; and finally, what the CVD risk factors are – tailored to their age – and how to avoid them.

A special feature of this publication is itsdifferent proposals, month by month, forpractising the theoretical advice given.Helped by an adult (parent or teacher)youngsters can, for instance, cut out a drawing each month on healthybehaviour and stick it on the last page, to obtain a drawing with the message that living in a healthy way is fun andeasy. There are also recipes and differentsuggestions for physical activity.

Training for the Olympic Games

During the "Healthiest Afternoon" (la TardeMás Saludable) the Spanish HeartFoundation, jointly with the Sports Counciland the local government, offered 7 to 16-year-old children a chance to spend all Saturday afternoon in a stadium withdifferent choices of physical and leisureactivities, with the aim of creating thehabit of regular physical activity.

In different areas, children practised sportswith instructors, made a circuit in theswimming pool with different games(basketball and other ball games,competitions, jumps, etc.) and played witha huge nutrition pyramid where differentteams competed, jumping on it andadvancing through the correct answersgiven about good and bad food.

Five hundred children participated,accompanied by their parents.

Discovering the secret of fruits

Also during this week, a theatreperformance called "The Secret of Fruits"was offered to 6 to 12-year-old children in 14 schools in Madrid during the Weekand on the Saturday afternoon. Done in partnership with a fruit producers’association, this piece was intended toincrease children’s intake of fruit andvegetables through information. A funnybook repeating the performance andcontaining information about fruit and its properties was given to children at theend, with some apples ‘to practise’.

Ten minutes can save a life

In partnership with SAMUR, the MadridEmergency Services, the Spanish HeartFoundation offered a cardiopulmonaryresuscitation (CPR) practical course taughtby professionals of this emergency service,which was called "Learn to save a life: youcan do it!" (Aprende a Salvar Una Vida).

Participating children learnt the basicsteps of CPR to act in an emergency and practised these techniques onmannequins, obtaining a diploma fromSAMUR.

Physical activity in the best company

In partnership with the Sports Council andlocal government, in the framework of the Heart Week dedicated to youngsters,two physical activities involved the wholefamily in building a healthy lifestyle:aerobic classes outdoors on a sunnySaturday morning, in the highest square of Madrid, and a "Healthy Heart Walk"(Marcha Corazón Sano), with extensiveparticipation of children and teenagers.The walk was started off by María Vasco,bronze medallist in the 20 km walk at the Sydney Olympic Games, whoencouraged children to complete thewalk through the historic sites, withcostumed actors enlivening the day.

News from Spainby the Spanish Heart Foundation

Spanish Heart Week turns to young people

HeartMatters14

How can we reach young people?

In 2000 The Netherlands HeartFoundation initiated a programme onhealth communication with youngsters.On the threshold of adulthood, youngpeople are making important decisions,including choices involving lifestyle andtheir future health. Since this group isnotoriously difficult to reach, theNetherlands Heart Foundation asked atrend forecaster, Ms Hanneke van derLinden, for advice. This article reflects hermain conclusions and suggestions. Theseinsights as well as the first phases of thecommunication programme werepresented at the European HeartNetwork annual workshop in Tuusla(2000) and Reading (2001).

What is on their mind

Between the ages of 12 and 18,youngsters are in search of their identity.This life phase can be labelled an age of role playing and games. Experimentswith different lifestyles are undertakenuntil one is found that ‘fits’. Theseexperiments with lifestyles are necessaryfor children to discover an identity oftheir own. It also offers an opportunity to play with values, beliefs, attitudes and habits; these are tested and eitheraccepted or rejected. At the age of 19,generally, minds are made up andchoices with a long-lasting influence on lifestyle become permanent.

In this interim period between childhoodand adulthood, youngsters areengaged in so many lifestyles that it isimpossible to speak of them as a singlegroup. With only age in common,youngsters make up uncountablegroups or subgroups. Each of them hasits own codes and culture.

What makes a lifestyle

Subcultures find fertile ground in ampletime and money, which young peoplehave. They offer some kind of structurewhen, for the first time, young peopleencounter the great themes of life.Subcultures offer a bond that providessafety and certainty when facing issuessuch as love, growing independence,and the many choices to be made forfuture life. Young people rather aremembers of tribes with clear codes,despite their self-declared individualismand independence.

This paradox is an important feature ofyouth culture. Choices and preferencesare not completely exclusive but seemto be added on to each other. A widerange of opinions and attitudes can bemixed: be a serious student through theweek and a hardcore party animal onthe weekend, for example.

Communication?

Heart foundations should not tailor their communication to one specificsubculture, however fashionable or trendsetting it might be. Moreover, youngstersdo not accept products or services thatare communicated in an inappropriatemanner. Or to put it differently: today’stypical young person is a seasonedexpert in how marketing and advertisingwork. Once a trick is seen through, thesender of the message is worse off thanbefore. For when something proves tobe not genuine, but merely made up, itis rejected. It remains uncertain whetherthe sender ever recovers from thismiscalculation when the image of anorganisation has proved to youngsters to be unreliable and fake.

Heart foundations should stick to their‘identity’ and be authentic. Valuesshould be defined and cherished. Acertain pride and authenticity gives aheart foundation more respect andauthority than an organisation which, for the sake of being understood, givesa bad imitation of their target group.

Heart foundations have a great asset intheir caring attitude. Sincere interest inyoungsters and their world, involvementand a respectful approach will beaccepted as added value. A certainstress on being caring – though notbeing patronising – is appreciated. Foryoungsters, life is not always easy or verymuch fun, and acknowledgement of this fact and support can be verycomforting and helpful.

Communication with youngsters shouldconnect with the great themes of life:the opposite sex, money and success.Not only do these themes encompass all different lifestyles and tribes, but theyalso represent primary drives. The senderof the message communicates withemotion – in communication emotion isa magic word. For effective communi-cation, heart foundations must speak toyoungsters’ emotions, keeping messagesclear and positive to ensure that theyoungsters addressed end up feelinggood about both message and sender.

News from The Netherlandsby The Netherlands Heart Foundation

Youth communication: a mission impossible?

HeartMatters

15

HeartMatters

For the last 25 years, DEFACTO, anorganisation for a smokefree future, hasbeen working to decrease smoking andsecond-hand smoke in Dutch society.DEFACTO is an initiative of The NetherlandsHeart Foundation, the Dutch CancerSociety and The Netherlands AsthmaFoundation. As 90% of Dutch smokers startsmoking before the age of 19, smokingprevention among youth is one of thecore businesses of DEFACTO.

Up to 1997, mass-media campaigns aimedto increase young people’s knowledgeabout the health risks of smoking. Due toseveral campaigns, in-school projects anda process of agenda setting in society,more than 80% of Dutch youngsters areaware of the health consequences ofsmoking.

However, there is more to smoking than health risks! The onset of smoking isalso influenced by the perceptions of(non)smoking and (non)smokers.Therefore, DEFACTO developed a newapproach and started a youth campaignthat focuses on a less cognitive, morepowerful determinant of smoking onset:attitudes towards smokers and non-smokers.

Between the ages of 12 and 16 thepercentage of smoking youngsters risesrapidly from 6% to 48%. In this period in lifeyoungsters feel very insecure. Qualitativeresearch has revealed that Dutchyoungsters associate smoking withindependence and being tough and cool.In contrast, non-smoking behaviour is seenas inferior.

An innovative campaign

To break down the existing attitude thatsmokers are cooler, tougher and moreindependent than non-smokers, DEFACTOdeveloped the “…but I don’t smoke”campaign. It is a three-year multimediacampaign, which started in 1998 andtargets 12 to 16-year-old non-smokers, with special emphasis on youth with lowersocial economic status.

The long-term goal of the campaign is to improve the attitudes of young peopleconcerning non-smokers. The strategy toupgrade non-smokers instead of down-grading smokers was chosen because of the high level of tolerance in theNetherlands. This overall atmosphere leads people to reject the downgrading of a person in general. In order to achieveattitude change, agenda setting andstirring up interpersonal communicationare defined as short-term behaviouralgoals. Furthermore, campaign awareness,likeability, and comprehension of themessage are necessary conditions for the communication to be effective.

Young people, especially young peoplewith a low level of education and lowsocial economic status, are well reachedby television. Therefore, the basis of thecampaign consists of TV commercials. Inorder to increase the contact frequency,the TV commercials are reinforced byradio commercials and a broad variety of activities ranging from free cards andcartoons in magazines to dance showsand live acts at school parties and in thestreets.

Channels and occasions are chosen fortheir ability to address young people inleisure situations. All of the campaigncomponents visualise the message that non-smokers are cool andindependent, too, in a humorous, strikingand daring way. Furthermore youngstersare challenged to use the campaignslogan in their own lives. That way, thecampaign infiltrates the youth scene and makes non-smoking the desirablething to do.

Promising results

Throughout the three years of thecampaign, continuing research has been performed to measure campaignawareness, knowledge of the message,subjective evaluation of the campaignand effects on attitudes towards non-smoking youth. All campaign componentshave been thoroughly pretested.

A tracking study in the first ten weeksrevealed that the exposure of thecampaign built up very rapidly. After ten weeks, exposure was almost 100%. Ofthe target population, 75% spontaneouslyremembered seeing at least one of thecommercials; 75% of the youngsters haddiscussed the campaign with friends; and almost 70% of the populationmentioned the use of the campaignslogan “… but I don’t smoke” by friends in real life. About 65% of the youngsterswere able to formulate the message ofthe campaign correctly.

The effectiveness of the campaign interms of attitude change will becomeclear after the post-test in the autumn of 2001.

News from The Netherlandsby DEFACTO, an alliance member of The Netherlands Heart Foundation

A provocative multimedia campaign to upgradethe young non-smoker

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Treatment for children from low-incomefamilies

Providing hope for children whose familiesdo not have the means to pay fortreatment for their congenital heartdisease is one of the important missionsthe Turkish Heart Foundation has taken on. Through a campaign called "Let OneHeart Beat for You", the Foundation sees to the medical examination, diagnosis and treatment of infants and children with congenital heart disease, withconsiderable and growing success.

"Let One Heart Beat for You" aims to raisefunds to help children from poor familiesthat do not have any social security ormedical insurance, so that they none-theless have a chance to lead a healthylife. The goal is to provide all theexaminations, tests, intervention andoperations that are required for theprecise diagnosis and treatment of suchchildren. Various activities are organisedeach year by the Board of Executives ofthe Turkish Heart Foundation.

Between 1997 and 2001, children withcongenital heart disease from 26 familieswere treated within the framework of the programme. The children werehospitalised for examination andtreatment in close collaboration with thePaediatric Cardiology and CardiothoracicSurgery Clinics of the University Hospitals.The variety of different heart conditionsthese children suffered were treated withthe latest medical techniques. During theirtreatment all the necessary medicines,and all the food as well is provided for the children. After treatment each child is given an annual check-up to ensure that they remain healthy.

In addition to the interventions, anaverage of 20 to 30 children per monthare given medical examinations and tests free of charge in the Turkish HeartFoundation Health Center.

Fundraising activities

For the last 26 years the Turkish HeartFoundation’s Board of Executives hasbeen organising cultural, social and artisticevents to raise the funds necessary tosupport examinations, tests, medicalintervention and surgery for children withcongenital heart disease whose familieslack the means to pay for their treatment.Such events are always a resoundingsuccess, with large audiences andextensive media coverage.

One recent fundraiser was a concert held in November 2001 by Turkey’s mostfamous folk singer. All proceeds from thisoutstanding performance by the singer,who was performing in Istanbul for the firsttime, and his orchestra, were donated tothe Turkish Heart Foundation. An especiallymoving moment was when severalchildren who have made a completerecovery from heart disease due to the"Let One Heart Beat for You" campaignjoined the singer on the stage to expresstheir gratitude and demonstrate the utilityof this life-saving campaign.

Ongoing testing

The Turkish Heart Foundation does heartscreenings in elementary and secondaryschools all over Turkey, in closecollaboration with and through jointprogrammes with the Turkish Ministry ofNational Education.

In the Turkish Heart Foundation’s Sisli HealthCenter in Istanbul, a specific departmentdevoted to paediatric cardiology hasbeen established.

News from Turkeyby the Turkish Heart Foundation

Helping children with congenital heart disease

HeartMatters

17

Creativity is often called for in persuadingyoung people to develop habits of goodnutrition and physical fitness that will helpthem avoid heart disease in later life. Two innovative campaigns by the BritishHeart Foundation (BHF) involve childrendirectly in learning and in convincing otherchildren to learn and practise good healthhabits.

Making a game of good eating habits

At the end of October, the BHF launched a new CD-Rom computer game to helpteachers and parents educate childrenabout healthy eating.

Research (Department of Health, 1997,Health Survey for England: The Health ofYoung People 1995 – 1997) shows thatfewer than one fifth of 2 to 15-year-oldseat fruit and vegetables more than once a day, which falls far short of therecommended daily intake of at least five portions of fruit and vegetables.Conversely nearly three quarters of 2 to 12-year-olds consume biscuits, sweets orchocolate every day.

Obesity is a major contributory factor tocoronary heart disease, the UK’s singlebiggest killer. Worryingly, the number ofobese six-year-olds has doubled in theUnited Kingdom in the last ten years (Reilly,J.J. and Dorosty, A.R., ‘Epidemic of obesityin UK children’, The Lancet; 27 November1999). The game "Nutrition Mission" isdesigned to tackle this problem early in lifein an exciting way, through a medium thatmany children relate to. By launching thisgame the BHF hopes that young peoplewill learn good eating habits that they willremember into adulthood.

The game features an eccentric professorwho helps youngsters learn about healthyeating through the "balance of goodhealth plate". Once players have learntabout the food groups, they can go to the cybermarket and choose from a widerange of foods to shop for each of thedaily meals for Artie Beat, a heart-shapedballoon with personality.

Artie Beat will play a variety of othergames with players if they can manage tokeep him happy by feeding him a healthydiet. But if his diet is poor, the cartooncharacter balloon will become unhealthy,unhappy and eventually go out with arather nasty bang!

“Nutrition Mission” has already been tried,tested and enjoyed by teachers andchildren alike. The new game is suitable for 7 to 11-year-olds and fits in with theirnational curriculum studies in all parts ofthe UK. It covers National Curriculum KeyStage 2 for Science, Scottish 5-12Environmental Studies and NorthernIreland Libraries Board Curriculum forScience.

"Let’s get Physical" campaign exploits thecompetitive spirit

The "Get Kids on the Go" campaign last year was incredibly successful athighlighting the issue of inactivity inchildren. The campaign, which waspredominantly targeted at adults, wasdesigned to bring the broad issue ofchildren’s health into the limelight. As part of the BHF’s 40th Anniversary it wasdecided that September was to build onthe "Get Kids on the Go" campaign. Thiswas done by honing in and focusing onone element – children and activity.

Children do not engage in enoughactivity, which is resulting in worrying levelsof obesity and putting them in danger ofdeveloping heart disease later on in life.The "Let’s get physical" activity aims tohelp tackle this problem. The BHF istargeting 7 to 16-year-olds and offeringthem practical and fun ways to exercise.The campaigns is intended to be positive,upbeat and educational, designed to"motivate rather than alienate".

The "Let’s get physical" activity waslaunched at the end of September withtwo main elements:

• A teenage competition called "Don’tjust sit there!". This invites 11 to 16-year-olds in schools, out-of-school clubs andyouth clubs to design a concept whichencourages their peer group to be moreactive. This could be a poster, leaflet,video or 3D object – the choice is theirs.The BHF encourages science andphysical education teachers to run thiscompetition with their pupils as part of the curriculum, and is promoting itthrough teachers’ and youth clubpublications and targeted leaflets toschools. The winning entry will beawarded a cash prize (to be dividedbetween the school and the entrant), as well as the chance to see theconcept used by the BHF as a resourcefor teenagers throughout the UK. Onefinalist from each region will go forwardto the national judging.

• A "Let’s get physical pocket play pack"for 7 to 11-year-olds. This pocket-sizedpack is full of ideas which show howbeing active can be fun. It has beendeveloped by the British HeartFoundation’s Education department in conjunction with the BHF NationalCentre for Physical Excellence. Childrenare invited to log their activity over sixweeks, and if it increases, they can sendoff for a free BHF certificate. This packwill be promoted again to teachers andchildren as well as play workers andparents.

News from the United Kingdomby the British Heart Foundation

Subtle encouragement for well-nourished,physically active children

HeartMatters

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National coordination: Belgian Heart LeagueContact person: Mr Jean-Pierre WillaertAddress: Rue des Champs Elysées 43

1050 BrusselsBelgium

Telephone: +32 2 649 8537Fax: +32 2 649 2828E-mail: ligue.cardio.liga@euronet.be

National coordination: Danish Heart FoundationContact person: Mr Hans SøndergaardAddress: Hauser Plads 10

DK-1127 CopenhagenDenmark

Telephone: +45 33 931 788Fax: +45 33 369124E-mail: hsoendergaard@hjerteforeningen.dk

National coordination: French Federation of Cardiology

Contact person: Mr Serge LafayeAddress: 50 Rue du Rocher

F-75008 ParisFrance

Telephone: +33 1 44 90 83 83Fax: +33 1 43 87 98 12 E-mail: slafaye@fedecardio.com

National Coordination: Finnish Heart AssociationContact person: Ms Anna Liisa RajalaAddress: Oltermannintie 8

SF-00620 HelsinkiFinland

Telephone: +358 9 752 752 23Fax: +358 9 752 752 50E-mail: anna-liisa.rajala@sydanliitto.fi

National coordination: German Heart FoundationContact person: Ms Renate GeusAddress: Vogtstrasse 50

D-60322 Frankfurt/MainGermany

Telephone: +49 69 955 1280Fax: +49 69 955 128 313E-mail: geus@herzstiftung.de

National coordination: Irish Heart FoundationContact person: Ms Marie Therese CrottyAddress: 4 Clyde Road

BallsbridgeDublin 4Ireland

Telephone: +353 1 668 5001Fax: +353 1 668 5896E-mail: mcrotty@irishheart.ie

National coordination: Italian Association against Thrombosis

Contact person: Mr Riccardo PiraniAddress: Via Cesare Correnti 14

20123 MilanItaly

Telephone: +39 02 720 11444Fax: +39 02 720 21776E-mail: trombosi.alt@galactica.it

National coordination: Netherlands Heart FoundationContact person: Ms Karen van ReenenAddress: P.O. Box 300

2501 CH The HagueThe Netherlands

Telephone: +31 70 315 5555Fax: +31 70 383 8752E-mail: k.van.reenen@hartstichting.nl

National coordination: Norwegian Council on Cardiovascular Diseases

Contact person: Ms Kirsti StrandAddress: Postboks 7139 Majorstua

N-0307 Oslo 3Norway

Telephone: +47 23 120 000Fax: +47 23 120 001E-mail: kist@nasjonalforeningen.no

National coordination: Portuguese Heart FoundationContact person: Dr Sofia LemosAddress: Joaquim Antonio de Aguiar,

64 2° D1070-153 LisboaPortugal

Telephone: +351 21 381 5000Fax: +351 21 387 3331E-mail: fpcardio@mail.telepac.pt

National coordination: Spanish Heart FoundationContact person: Ms Beatriz JuberiasAddress: Ntra. Sra. de Guadalupe, 5-7

28028 MadridSpain

Telephone: +34 91 724 2373Fax: +34 91 7242374 E-mail: fec@secardiologia.es

National coordination: Swedish Heart Lung FoundationContact person: Ms Janina BlombergAddress: Riddargatan 18

S-11451 StockholmSweden

Telephone: +46 8 566 24217Fax: +46 8 566 24229E-mail: janina.blomberg@hjart-lungfonden.se

National coordination: National Heart ForumContact person: Ms Louise SarchAddress: Tavistock House South

Tavistock SquareLondon WC1H 9LGUK

Telephone: +44 207 383 7638Fax: +44 207 387 2799E-mail: louise.sarch@heartforum.org.uk

European Heart Network

Mrs Susanne LøgstrupDirector

Rue Montoyer, 31B-1000 BrusselsBelgium

telephone: +32 2 512 9174fax: +32 2 503 3525e-mail: ehn@skynet.bewebsite: www.ehnheart.org

European Heart Health Initiative National Coordination

Ms Rosemary CoelhoEHHI European Coordinator

telephone: +32 2 502 1541fax: +32 2 503 3525e-mail: ehhi@skynet.be

Contact

EUROPEAN HEART HEALTH INITIATIVEThis European Heart Network acknowledges the financial support

received from the European Commission for this project. Neither theEuropean Commission nor any person acting on its behalf is liable for

any use made of the following information.

The mission of theEuropean HeartNetwork is to play a leading rolethrough networking,collaboration andadvocacy in theprevention andreduction ofcardiovasculardisease so that itwill no longer be a major cause ofpremature deathand disabilitythroughout Europe.

www.karakas.be

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