Part1: can we eradicate CVD

• Risk factors for CVD from highest to lowest:

  • diet
  • tobacco
  • high BMI
  • high systolic blood pressure
  • alcohol and drugs
  • high fasting plasma glucose
  • high total cholestrol
  • low glomerular filtration rate
  • low physical activity rates
  • occupation risk
  • air pollution
  • low bone mineral density
  • malnutition
  • sexual abuse and violence
  • other environment risks
  • unsafe sex
  • unsafe sanitation
• Bell-Curve shift in populations:

  • shifting the whole population into a lower risk category benefits more individuals than shifting high risk individuals into a lower risk category

  
• Determinants of Health:

  • determinants can cause risk factors
  • determinants include:
  • general socioeconomic, cultural and environmental conditions
  • living and working conditions
  • social and community influences
  • individual lifestyle factors
  • age, sex & hereditary factors

  
• Smoking Cessation Interventions:

  • Capewell and Capwell et al research an effectiveness hierarchy of preventive interventions
  • population based approaches, such as increasing price of tobacco, seemed to be the most effective methods

  
• Diet related approach:

  • interventions such as promoting farmers to harvest more beneficial foods for cardiovascular health saw more of an improvement in cardiovascular health

  
• Evidence based strategies to increase physical activity:

  • Gregory et al 2012
  • community wide and mass media campaigns, and short physical activity messages targeting key community sites are recommended
  • behavioural and social approaches are effective, introducing social support for physical activity within communities and worksites, and school based strategies that encompass physical education, classroom activities, after school sport and active transport
  • recommended environmental and policy approaches include creation and improvement of access to places for physical activity with informational outreach activities, community scale and street scale urban design and land use, active transport policy and practices, and community wide policies and planning
  • thus many approaches lead to acceptable increases in physical activity among people of various ages, and from different social groups, countries and communities
• Physical activity related:

  • capewell and capewell study
  • economic crisis caused the largest increase in active adults, due to fuel being too expensive
  • this also showcases the upstream affect

  
• • population based approaches are powerful, rapid and equitable
• • high risk strategies typically widen the gap in health inequalities
  • up take may be high in the more affluent, asserted and better educated etc
  • population based approaches typically narrow health inequalities
  • benefit everybody
  • the most deprived groups typically have the most greatest burden of disease so they get the most benefit
• concluding statement:

  • multinationals are the major drivers of the NCD epidemic, they profit from the sale of harmful commodities
  • similar tactics are strategies to tobacco to undermine public policies and programmes - essentially one could argue opposing the health of our patients
  • evidence based recommendations = regulation and market intervention ie taxation and subsidies
• Tactics used by tobacco and food industries to block market regulation:

  • misinformation
  • attack
  • recruit constituencies
  • substitute ineffective interventions
  • heap money onto politicians, journalists and scientists
• so can we eradicate CVD:

  • CVD/NCD burden is immense, but much is preventable (especially premature disease)
  • upstream approaches are most effective
  • many examples of public health success to learn from e.g. safe drinking water, seat belt legislation, smoke free legislation