Public Health interventions - Global Cardiovascular Disease

As the cardiovascular disease epidemic adds to existing burdens in developing countries, the challenges are great, but a multitude of opportunities also are available to stem this tide, starting with population level interventions. Fortunately, current knowledge about the causes of cardiovascular disease can direct public health interventions. Although genetic variability exists among different ethnic groups, common environmental risk factors such as obesity, high saturated fats diets, and smoking play major roles in the development of cardiovascular disease. Public health efforts aimed at minor changes in behaviors such as smoking cessation, lifestyle and diet modifications, and exercise can lead to significant reductions in cardiovascular morbidity and mortality. In primary prevention, the strategy is often on a population level, seeking to reduce the burden of disease in the community as a whole, frequently resulting in only smaller benefits to individuals. In secondary prevention, the strategy is to treat high-risk patients, providing larger benefits, but to fewer individuals.[15] In both cases, limited resources unfortunately hinder treatments and accessibility to primary and specialty care providers.

In seeking solutions to this problem, one must first identify the public health intervention challenges, and then, the opportunities. For many years, population control, infant survival, and infectious diseases have been the focus of global health resources. Many countries must deal with a multitude of barriers to the provision of high-quality health care, such as lack of education, health care provider shortages, and limited access to medications. Currently, few investments and fewer resources are directed toward preventing chronic disease compared with the resources directed at infectious diseases. In addition, political strife, migration (forced or otherwise), rebellions and war, and the inability to achieve cooperation among leaders have been major obstacles to creating sustainable long-term solutions. Public policy efforts in cardiovascular health need to become a government priority to create the appropriate environment for reducing this disease burden.

The development of a health care infrastructure, such as having a trained health care workforce, pharmaceutical distribution networks, and community clinics and hospitals, must be established to allow community leaders and health care workers to administer basic services and education programs.

Fortunately, in many countries, an infrastructure exists for the treatment of infectious diseases such as HIV/AIDS and tuberculosis. Developing countries can build on the infrastructure for these infectious diseases by providing additional cardiovascular training for health care workers, utilizing similar drug procurement programs to obtain antihypertensive and lipid-lowering agents, and creating policies that facilitate the screening and treatment of cardiovascular disease at the same clinics and outreach programs that currently focus on infectious diseases.