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Heart disease: the rich/poor divide

A new global analysis reveals that some of the poorest countries in the world have among the highest age-standardised mortality rates of cardiovascular disease

A new global analysis has revealed that some of the poorest countries in the world have among the highest age-standardised mortality rates of cardiovascular disease (CVD).

The data, launched ahead of the United Nations High-Level Meeting (HLM) on Non-Communicable Diseases, reveals growing inequalities in the cases and deaths of CVD between countries and populations, with the percentage of premature deaths from CVD more than twice as high in low-income countries compared with high-income countries.1

The Global Atlas on Cardiovascular Disease Prevention and Control also shows that by taking action to curb CVD risk, governments and individuals can reduce the health and socioeconomic burden caused by these diseases.1

“Heart disease and stroke, together with other cardiovascular diseases, are often wrongly seen as diseases of affluence, although they affect the poor as well as the rich,” said Dr Shanthi Mendis, Coordinator of CVD, World Health Organization (WHO).

“The new Global Atlas data reveal that although death rates from CVD have been declining in high-income countries over the past two decades, they have increased at an astonishingly fast rate in low- and middle-income countries. Now is the time for us to invest in affordable health interventions to ensure that the world's poorest people are not subject to the growing CVD burden in addition to communicable diseases.”

CVD remains the biggest cause of deaths worldwide. More than 17 million people died from CVD in 2008, with 82% of deaths occurring in low- and middle-income countries. More than 3 million deaths occurred before the age of 60, many of which could have been prevented through the modification of risk factors: tobacco use, unhealthy diet, lack of physical activity, excessive alcohol consumption and strengthening
primary care.1

“The data reveal that CVD impacts a significant number of people during their most productive years, affecting families and societies in terms of healthcare, lost productivity and worsening poverty.  For example, a family who lose a young parent to CVD not only face the emotional consequences, but also face the prospect of malnourishment and financial debilitation,” said Professor Pekka Puska, Board Member, World Heart Federation.

“This provides a wake-up call for governments and individuals to act now to reduce exposure to CVD risk factors by banning tobacco, limiting levels of sugar, saturated fat and salt in foods, encouraging physical activity, and increasing taxation of alcohol.”

Since CVDs are largely preventable, measures to decrease risk factors coupled with improved access to healthcare through a primary healthcare approach could save millions of lives.  However, lack of awareness and overstretched health services mean that many people with CVD in low- and middle- income countries remain undiagnosed or cannot access the treatment they need.  

The Global Atlas is a joint publication of the WHO, the World Heart Federation and the World Stroke Organization (WSO). The publication reveals country-specific CVD rates, therefore pinpointing where government, individual and donor action is most needed to address the growing global burden. Some of the poorest countries in the world (such as Afghanistan, Somalia and Malawi) have among the highest age-standardised CVD mortality rates.1

However, data from the Global Atlas also encouragingly reveal that prevention and intervention strategies to tackle CVD can contribute to a reduction in CVD events, as seen in most high-income countries over recent years.1

The new Global Atlas is published ahead of the United Nations HLM on Non-Communicable Diseases taking place on 19-20 September in New York. CVDs are the most significant group of non-communicable diseases in terms of the number of deaths and level of disease they cause.

This is only the second time the United Nations has convened a special summit on a specific health issue and is recognition of the importance of this group of diseases globally as a threat to human health and a hindrance to economic development.

The newly assembled data and analysis confirm that heart disease, stroke and other CVDs are together the leading cause of death and disease in the world. “It is no longer the case that the majority of deaths are caused by infectious disease,” said Professor Bo Norrving, President of the WSO. “This data provides the evidence for the necessity of next week's Summit; the world needs to invest much more, and more quickly, in preventing and treating CVD. There is no time to lose.”

To meet the need for increased resources for CVD prevention and treatment, innovative thinking by governments and individuals is needed to develop and generate new sources of funding - such as new or increased taxes on tobacco and on alcohol. Monies raised from these new revenue sources can be spent directly on highly cost-effective programmes to prevent and control non-communicable diseases, including CVD.

Reference
1.    Global Atlas on cardiovascular disease prevention and control. World Health Organization, World Heart Federation and World Stroke Organization. 2011

Resources
World Heart Federation
www.worldheart.org
   
World Stroke Organization
www.world-stroke.org