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Abstract: Objective: High blood pressure is an important and modifiable cardiovascular disease risk factor that remains under-detected and under-treated. Community-level interventions that address high blood pressure and other modifiable risk factors are a promising strategy to improve cardiovascular health in populations. The present study is a community cluster-randomised trial testing the effectiveness of CHAP (Cardiovascular Health Awareness Program) on the cardiovascular health of older adults. Methods: Thirty-nine mid-sized communities in Ontario, Canada were stratified by geographic location and size of the population aged ≥65 years and randomly allocated to receive CHAP or no intervention. In CHAP communities, residents aged ≥65 years were invited to attend cardiovascular risk assessment sessions held in pharmacies over 10 weeks in Fall, 2006. Sessions included blood pressure measurement and feedback to family physicians. Trained volunteers delivered the program with support from pharmacists, community nurses and local organisations. Results: The primary outcome measure is the relative change in the mean annual rate of hospital admission for acute myocardial infarction, congestive heart failure and stroke (composite end-point) among residents aged ≥65 years in intervention and control communities, using routinely collected, population-based administrative health data. Conclusion: This paper highlights considerations in design, implementation and evaluation of a large-scale, community-wide cardiovascular health promotion initiative. [Copyright &y& Elsevier]

In their paper, "The Public Health Enterprise: Examining Our Twenty-First-Century Policy Challenges," Tilson and Berkowitz outline six challenges for the United States public health enterprise: infrastructure, essential services, preparedness, accountability and measurement, workforce and the research agenda. Canada also has challenges in these areas. This paper briefly outlines examples of what is being done to respond to these challenges, the current state of public health in Canada and directions being taken in Canada for the future. There are striking similarities in the public health system challenges facing the United States and Canada, despite major differences in organization and financing of healthcare in the two countries. Planning, implementation and evaluation of public health approaches require different management skills and knowledge than for personal healthcare. Both countries must keep up their recent momentum to improve their official public health infrastructure, agreement on essential services, emergency preparedness, accountability and measurement, workforce and research agenda.