In January 1998, the Public Health Service Act (OGDG) was put into force by North Rhine-Westphalia's state parliament as Article 3 of the Act on the Strengthening of the Efficiency of Districts, Cities and Municipalities. The objective of the Public Health Service Act is the performance of functions through the public health service in a way which corresponds to problems, ambitions and priorities at the local level. The effects of the Act have been documented over a period of 5 years. The authors describe the method of evaluation and the most important results. As well as describing traditional tasks, they focus in particular on process and structural data of the local health conferences. These have been introduced as a consequence of the Public Health Service Act in all 54 districts and self-administered cities in North Rhine-Westphalia. Another task which has become obligatory as a result of the Public Health Service Act is health reporting. Here, the authors report on the state of affairs with regard to implementation, major topics and differences in concept. Based on the state of development at the end of 2002, the authors describe present developments and prospects. They expect continuous need for support, particularly in the fields of health conferences and health reporting.

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The "Consensus-Conference" of the European Atherosclerosis Association held in June 1986, came to an agreement, that all adults with cholesterol levels above 200 mg/dl should receive medical attention. First representative investigations in the Federal Republic of Germany showed that levels below 200 mg/dl are found in less than 30% of persons aged 30 to 59 years. 76% of all patients who where examined didn't know their own cholesterol level. These data verify the urgency of intensive preventive actions. Cholesterol screening without simultaneous supply of information for behaviour modification (especially nutrition education), would be of little use. Therefore in the proposed screening-concept communicative procedures are of great significance. In addition, cooperation between physicians, psychologists, teachers and suitable organisations is necessary.

The increased relevance of cardiovascular prevention for improved population health is mainly a result of recent epidemiologic research. The identification of essential risk factors of the arterio-sclerotic process as well as their interventive modification are generally accepted. The prolongation of the life-expectancy has been achieved more and more by preventive successes in higher age. Participation of the individual and cooperation of institutions are essential prerequisites of the necessary life style change. The German health offices have to be prepared for essential functions in health management.

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