Developing a Strategy for Cardiovascular Disease: Surveillance, Prevention and Healthcare
Keywords:
Cardiovascular disease - Non-communicable disease - Public health.Abstract
Introduction
Cardiovascular diseases are a major component of non-communicable diseases and include coronary heart disease, stroke and peripheral vascular disease. Public health strategies to address cardiovascular disease require three elements: surveillance, health promotion, and individual health care.
Methods
Surveillance includes monitoring of mortality and morbidity as well as surveys to monitor risk factors levels in the community. Data on mortality from cardiovascular diseases are readily available and analysed by age and sex specific rates looking are secular trends, geographical and ethnical group variations and international comparisons. However many deaths from cardiovascular disease occur suddenly and the cause of death may be registered without autopsy or any other validation. Cardiovascular morbidity information is more difficult to collate and interpret as it is closely related to availability and access to health care. Periodic surveys of cardiovascular risk factors are essential in monitoring the underlying trends in blood pressure, smoking, cholesterol, obesity, and diabetes as they predict future trends, and support planning for prevention and healthcare.
Results
Prevention and health promotion activities are informed by the levels and trends in cardiovascular disease and its risk factors. There has been debate about population health promotion and individual health care strategies, but both are necessary. Cigarette smoking, nutrition and physical exercise are the main behaviours to be addressed but these are complex and require multifaceted approaches. Education alone is insufficient to change health behaviours and health promotion needs to look to changing attitudes. Legislation, taxation and other fiscal interventions have been shown to be effective however these can be difficult for legislators as there are other competing interests, particularly in the area of nutrition and tobacco. Creating health promoting environments that make healthy behaviour choices easier can be beneficial.
Conclusions
Health care interventions are also effective in reducing the burden of cardiovascular disease. A balanced approach of health promotion and individual health care is recommended in the development of a strategy for cardiovascular disease.
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References
World Health Organisation. 2008-2013. Action Plan for the Global Strategy for the Prevention and Control of Non-communicable Diseases. World Health Organisation, Geneva; 2008.
World Health Organisation. Global Status Report: Non-Communicable Diseases 2010. World Health Organisation, Geneva; 2011.
Smith W C S, Tunstall-Pedoe H D. European regional variations in cardiovascular mortality. Br Med Bull. 1984; 40: 374-379.
Nichols M, Townsend N, Scarborough P, Rayner M. Trends in age-specific coronary disease mortality in the European Union over three decades: 1980-2009. European Heart Journal. Available from: doi:10.1093/eurheart/eht159.
World Bank. The growing danger of non-communicable diseases. World Bank. 2011 Sept.
MONICA. World’s largest study of heart disease, stroke, risk factors and population trends 1979-2002. World health organization, Geneva; 2003.
World Health Organisation. NCD Country profiles: Malaysia. World Health Organisation, 2011.
World Health Organisation. STEPwise approach to surveillance (STEPS) [Internet]. [cited 2014 Feb 10] Available from: http://www.who.int/chp/steps/en/
Institute of Public Health. National Health and Morbidity Survey 2011 (NHMS 4). Ministry of Health, Malaysia; 2013.
Scottish Health Survey. The Scottish Health Survey 2011. Scottish Government, Edinburgh; 2012.
Smith W C S, Lee A J, Crombie I K, Tunstall-Pedoe H D. Control of blood in Scotland - the rule of halves. Br Med J. 1990; 1: 981-983.
Letchuman GR, Wan Nazaimoon WM, Wan Mohamad WB et al. Prevalence of diabetes in the Malaysian National Health Morbidity Survey III 2006. Med J Malaysia. 2010; 65:173-179.
Geneau R, Stuckler D, Stachenko S et al. Raising the priority of preventing chronic diseases: a political process. Lancet. 2010; 376:1689-1698.
World Health Organisation. Malaysia: country cooperation strategy 2009-2013. World Health Organisation, Geneva; 2010
Gornall J. Scotland’s battle over alcohol pricing. Br Med J. 2014; 348:15-17.
Lock K, Smith RD, Dangour AD et al. Health, agricultural and economic effect of adoption of healthy diet recommendations. Lancet. 2010; 376:1699-1709.
Cecchini M, Sassi F, Lauer JA, Lee YY, Guajardo-Barron V, Chisholm D. Tackling of unhealthy diets, physically inactivity and obesity: health effects and cost-effectiveness. Lancet. 2010; 376:1775-1784.
Scottish Intercollegiate Guidelines Network. Risk estimation and prevention of cardiovascular disease. Scottish Intercollegiate Guidelines Network, Edinburgh; 2007. 2
Fifth Joint Task Force of the European Society of Cardiology European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). European Heart Journal. 2012; 33:1635–1701.
Ford ES, Ajani UA, croft JB et al. Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980–2000 N. Engl J Med
