PREVENTION ABOUT CARDIOVASCULAR DISEASES

For many years, organizations have sought to prevent the development of coronary heart disease in the many countries of the world. The World Health Organization (WHO) in its constitution states that health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. In the declaration of Alma Ata in 1978, it is further stated that the existing gross inequality in the health status of the people, particularly between developed and developing countries, is politically, socially, and economically unacceptable, and it is therefore of common concern to all countries. Others have spoken of the moral principles underlying the care of others.26–28 However, it is only recently that this problem has been approached more directly. The Framework Convention on Tobacco Control adopted at the 56th World Health Assembly in 2003 has had considerable impact around the world, not only in encouraging countries to introduce legislation, but also in changing the mood and minds of the public to regard smoking as the loathsome habit it is. Equally, the Global Strategy on Diet, Physical Activity, and Health, which was adopted at the 57 World Health Assembly in 2004, may have the same consequence. Informing the public and politicians of the size and nature of the problem may have greater consequences overall than many other approaches. Those responsible for intervening are many, but too often groups of experts claim this problem to be their own. The greatest need is for more cooperation among experts. Epidemiologists, health economists, the media, and politicians need to demonstrate a more active role. Nurses, health workers, and primary physicians can influence the public and patients and their families. Hospital physicians, cardiologists, and university scholars must emphasize the importance of the prevention of disease rather than the cure of the acutely ill. There is a role for medically qualified persons, but a greater role in prevention for those who work in professions closely allied to medicine. Perhaps the greatest responsibility resides with political leaders who need to consider the implications for coronary heart disease when making political decisions on socioeconomic factors in a country and on fiscal matters. Reducing multiple risk factors will not bring about total equity around the world in terms of healthy life expectancy, but it will reduce substantially the current differences in equality. The reduction in the costs of drugs as they come off patent will make them more available to the global population. International collective action,30 engagement of developed countries,31 action by civil society,32 and above all, involvement of the public and patients are essential for a successful program of prevention. 

The preventive approach to heart disease is undervalued and underused around the world. This is partly because of a lack of knowledge and partly because of the desire of physicians to treat the acutely sick. Gains from prevention are not immediately evident so that the elation associated with bringing about an immediate impact on a patient’s condition is absent. Some commercial interests may obstruct policy.