Each year, cardiovascular disease, or CVD, kills nearly 18 million people — accounting for one-third of global deaths. A complex health issue related to a number of other chronic conditions, in Europe, CVD is the number one killer — responsible for 37 percent of deaths recorded in the European Union in 2013. Treating CVD is also one of the biggest and fastest growing burdens on national health care programs worldwide, prompting the World Health Organization to create a global action plan for the prevention and control of diseases that calls for a 25 percent reduction in premature mortality from CVD.
“There’s a critical linkage between aging and cardiovascular health,” said Michael W. Hodin, chief executive officer of the Global Coalition on Aging, raising concerns about changing global demographic data: By 2020, the population of people over the age of 60 will reach 1 billion — a number that is expected to double by 2050, at the same time that birth rates around the world continue to drop.
“In respect to health care, we are not only likely to see a greater prevalence of cardiovascular disease, but the proportion of society at risk over the next three to four decades will become much greater,” he said. “This is why public policy needs to have a much greater focus on the prevention and treatment of cardiovascular disease.”
But while governments are working hard to achieve this goal, their efforts are falling short according to “Global heart health: Evaluating efforts to promote healthy hearts,” a new intelligence report by The Economist Group, that assesses and ranks countries according to the effectiveness of their cardiovascular health policies.
Devex looks at some of the key findings of the report, including the best practice policies that governments can adopt to lower heart disease among their populations, and also where policy gaps remain.
Setting strategic policies for better heart health
According to Martin Koehring, managing editor and global editorial lead of Healthcare Thought Leadership at The Economist Intelligence Unit, effective cardiovascular policy should include five key ingredients:
- A well thought out, long-term strategic plan.
- Effective policies, for example public health campaigns that raise awareness about risk factors for major heart disease.
- Adopting best practices — such as multidisciplinary, integrated care pathways.
- Improving patient access to care, for example cardiac rehabilitation programs.
- Creating patient-focused cardiovascular initiatives.
But the first step governments should take to comprehensively address the challenges of CVD, Koehring said, is to create a strategic plan.
“A good strategic plan should be comprehensive, outline specific objectives, set out a method and a timeline to achieve those goals, including monitoring and evaluation, and show progress in implementation and follow through,” he added.
Strategic plans are particularly crucial when addressing the challenges of a disease as complex and widespread as heart disease; without such a plan, successfully budgeting for prevention and treatment is nearly impossible, making it difficult to collect data on treatment outcomes, and to learn from previous experiences.
Surprisingly, eight of the 28 countries surveyed — including France, Finland, Germany, Austria, Belgium, Nigeria, Egypt and Saudi Arabia — have no strategic plans whatsoever, and four others haven’t updated their plans at all in the past five years. Even those that have top marks on comprehensiveness and in identifying objectives, such as Portugal, sometimes fall short on implementation.
Comprehensiveness is another area where the vast majority of countries fall short. According to the report, only three countries — Canada, Russia, and the United States — have plans that address the historic patient numbers, future trends and access to innovation, and include concrete policy steps. These can include awareness-raising campaigns, the inclusion of prevention strategies or integrated and multidisciplinary treatment, among others.
Creating effective cardiovascular policy interventions
Once the strategic plan is in place, the next step is to put effective cardiovascular policies into place. These can take a number of forms — such as increasing the regulation of potentially harmful products, including tobacco and sugar, or awareness-raising campaigns.
According to Dr. David Wood, Garfield Weston professor of cardiovascular medicine at the International Center for Circulatory Health at Imperial College London, governments should push through more policies that focus on preventative care.
“At the moment, most government resources go into caring for the sick, rather than preventing the development of the disease in the first place,” said Wood. “While there needs to be a national policy for those who have developed the disease, there needs to be more focus on screening, and reaching the people who are at high risk of developing the disease.”
One way to do this is through publicity campaigns that raise awareness about key risk factors for heart health, such as the impact of tobacco use, and the importance of physical activity and healthy diets.
Finland’s North Karelia project provides an example of a successful comprehensive cardiovascular policy intervention: In the early 1970s, Finland had one of the highest mortality rates from CVD in the world. By combining a comprehensive approach to battling CVD — starting with identifying risk factors specific to the Finnish population, followed by interventions at community-level organizations, and aggressive national media campaigns over the span of several decades — the country has witnessed dramatic results: Today, smoking has halved; dietary changes have reduced mean cholesterol levels of the population by 17 percent; elevated blood pressure has been brought under control; and physical activity has increased, according to a WHO report evaluating the intervention.
Ensuring that cities that are accessible to aging populations is also vital, according to Hodin.
“Most developed countries have aging populations now, who are also at a much higher risk for cardiovascular disease,” he said. “By creating age-friendly cities, we ensure that the elderly remain engaged, economically, socially and physically.”
For example, cities can become more age-friendly by providing appropriate housing and transportation, age-friendly community spaces, employment opportunities and by promoting intergenerational venues.
Wood also advocates greater legislation of potentially harmful products — such as tobacco and sugar — that raise risk factors for heart disease, and points to tobacco control as an illustration of how legislation can affect cardiovascular outcomes on countries’ populations.
To do this, governments should adopt regulations that discourage unhealthy behaviors — by taxing tobacco products, for example, or prohibiting food companies from including harmful sweeteners or preservatives.
“The countries that have raised taxes on tobacco products and prohibited smoking in public places have seen major reductions in the smokers, per capita — which translates to better cardiovascular outcomes,” said Wood.
In addition to tobacco legislation, he sees potential for policy interventions in the industrial use of trans-fatty acid — which is generally used by food companies to increase the shelf life of products, has no nutritional value, and contributes to obesity and diabetes.
“From the perspective of lifestyle we need legislation to control the production and marketing of foods,” he said. “We’ve seen the impact with tobacco, and need to take it further.”
Creating accessible, integrated cardiovascular health systems
Finally, governments need to ensure that cardiovascular care is accessible to patients, and that cardiovascular treatment is integrated and comprehensive.
“Having multidisciplinary care is really important, because it means that your patient is really at the center of care, rather than being siloed into just one part of the care system,” said Koehring.
In terms of best practice, that means ensuring that primary and secondary care are well integrated, so that patients’ records and treatments are easily accessible to health professionals across facilities. It also means creating cardiovascular treatment centers and units, which treat all aspects of the disease — including extensive monitoring and evaluation, prevention and rehabilitation.
This can be particularly critical in developing countries, which don’t often have the same resources as their wealthier peers. That’s where public-private partnerships can play a critical role.
“In Romania, for example, there are three cities have introduced cardiovascular units — and that’s because of PPP’s,” said Koehring. “It’s a way that the private sector can provide support to some of these initiatives.”
Ensuring greater patient access — both in terms of affordability, advocacy and access to innovative technology and treatment — is also critical.
“Lack of government funding often means higher out of pocket expenses, which in turn affects a patient’s ability to seek appropriate care when they need it,” said Koehring.
Creative use of technology is increasingly being applied to improve patient access in developing countries, where resources are limited — at times, setting innovative examples that developed countries could learn from. For example, junior doctors in India often share electrocardiogram results with supervisors who might not necessarily be on site, allowing them to tap their colleague’s expertise and provide superior care to their patients, according to the report.
Additionally, the proliferation of “e-medicine” in developing countries is also opening new avenues to patient access to cares in remote areas that would otherwise have none.
However, heart disease remains one of the biggest killers in the world, and its mortality rate is only likely to increase, as both developed and developing countries deal with an increasingly older demographic. The policies that countries put into place now will have very real consequences on this disease: By creating long-term, thoughtful strategic plans, and implementing policies — such as effective advocacy and public-awareness campaigns, integrating health care treatments, and reducing out-of-pocket costs — governments and policymakers have the capacity to make a real difference in patient outcomes.
“We are already making great progress, but we can still do better,” said Koehring. “While before it was about preventing death, now it’s about implementing measures that can improve the quality of life of people living with heart disease for years to come, and help prevent newer generations from ever getting it.”
For more information on the challenges countries face in reducing premature mortality due to cardiovascular diseases, join a special event at the World Health Assembly in Geneva, Switzerland on May 24, “Global Heart Health and the Road to 2025.” Co-hosted by Devex, the International Alliance of Patients’ Organizations, and the World Heart Federation, panelists will discuss the opportunities for innovation in disease prevention, management and treatment in an ageing world.