Health is central to the achievement of the MDGs and three goals are explicitly targeted at health issues: to reduce child mortality; to improve maternal mortality; and to prevent the spread of HIV/AIDS, malaria and other diseases. However, heart disease (a chronic disease) which affects the majority of the world's population has not been included within the global targets.
Heart disease was the leading cause of death in 2005 - accounting for 17.5 million out of the 58 million recorded deaths (80% occurred in developing countries). In contrast, the infectious diseases targeted in the MDGs caused only 2.8 million deaths from HIV/AIDS, 1.6 million from tuberculosis, and 0.8 million from malaria. Thus, heart disease caused 3.3 times more deaths than the infectious disease combined. Despite this distressing data, little global attention is being paid to the challenge of reducing this burden in developing countries.
Poverty increases the risk of developing heart disease and also increases the chances of developing complications and dying prematurely. Heart disease in developing countries, largely through the combined effects of tobacco, unhealthy diets, physical inactivity and overweight, strikes the younger working age people that portend a negative impact on economic growth. By adulthood, overweight children are 3-5 times more likely to suffer a premature heart attack than are children of normal weight.
Heart disease inflicts an enormous direct or indirect economic burden on the poor, and pushes many people and their families deeper into poverty. Acute events like heart attack or stroke– can be ruinously expensive, and are indeed so for millions of people in the developing countries. People who fall ill often face a dire choice: either to suffer and perhaps die without treatment, or seek treatment and push their family into poverty. Those who suffer from long-standing heart disease are in the worst situation because the costs of expensive medical care are incurred over a long period of time.
It is instructive to take a cursory look at six programmes and initiatives that have made significant impacts on heart disease prevention and control in global populations. First, community-based programmes have proven potential as an approach to heart disease control. A typical example is the North Karelia Project in Finland, launched in 1972 as a community-based programme that influenced diet, blood pressure and physical activity - factors which are essential in the prevention and control of heart disease. Evaluation showed how the diet (particularly fat consumption) changed and led to a major reduction in population blood cholesterol and blood pressure levels in Finland.
Second, work site/ employer based health programmes are cost-effective for the employer and are most effective when they include the establishment of an infrastructure that promotes health education, professional training, detection and management of high blood pressure patients, dietary counseling (including a focus on salt intake and reducing overweight), quitting smoking and restricting alcohol.
Third, the WHO Global Strategy for Diet, Physical Activity and Health, which provides a framework for multistakeholder interventions to promote increased physical activity and healthier diets. Similarly, the National Heart Foundations Food Labeling programmes that promote heart-friendly foods have proven to be useful in modifying fat and salt intake in populations.
Fourth, the Framework Convention on Tobacco Control ( FCTC), the world's first global treaty, ratified by 168 countries provides governments, the medical profession and NGOs with suggested policies and programmes for reducing tobacco use. Its provision has proved to be effective.
Fifth, awareness-building efforts such as the World Heart Day and the Go Red for Women Campaign (designed to raise awareness among women of their risk of heart disease) are cost–effective means to educate populations.
Sixth, professional organizations and NGOs should collaborate and adapt international management guidelines to meet the real needs of patients. Such associations should lead the health promotion activities and education efforts for the primary care physicians. Drugs that are affordable, effective and locally manufactured should be promoted.
Are there examples of countries that have domesticated their Health-MDG goals? Mauritius, Thailand, Indonesia, and Lithuania are few developing countries that have successfully adapted heart disease to their MDG goals. Nigeria needs to join the league of countries that have recognized this bold breakthrough towards improving the health of the population and fast-tracking the achievement of the MDG goals.
HIV/AIDS has an infectious origin but requires long-term management by the healthcare system. Therefore, it has a great deal in common with management of heart disease. For the health system to deliver those interventions over long periods of time, there is a great demand on the financing, human resources, and information base of the health system. It is therefore, more prudent to create a model that integrates HIV/AIDS and heart disease, to work together in symbiosis to strengthen the health system.
Now the big challenge! How about funding? Currently there are no Global Funds, no Presidential Emergency Plan, and no programme devoted to “Rolling Back” heart disease. The expectation has been that the same international funders of Action against HIV/AIDS, Tuberculosis and Malaria would start supporting a broad range of health issues. It is highly unlikely that those funders will provide support for programmes on chronic disease – heart disease, stroke, cancer and diabetes. The time has come to challenge sectors of our own society such as business, labour and NGOs to join governments at all levels and become involved in prevention and control of heart disease.
Just as Exxon-Mobil is attacking malaria in Indonesia and Nigeria, multinational companies should extend their corporate social responsibilities to adopt a heart disease like hypertension. Also a state or local government could be adopted for the inception of a community–based intervention initiative for heart health. Corporate bodies could create incentives like building parks or walk ways to increase physical activity, or ensuring that people with heart disease are diagnosed early or have access to affordable, effective and accessible, locally manufactured drugs.
With the current evidence that heart disease causes three times more deaths than infectious diseases [HIV/AIDS and Malaria] combined, urgent action is needed to adapt for our own purpose MDG6 to read “ combat infectious disease such as HIV/AIDS and Malaria, along with heart disease using an integrated approach” for effective achievement of poverty reduction.
