Resistance in Preventing Non Communicable Diseases

Tuesday, 16 February 2010 00:00

The loss of life, disability, and economic burden attributed to non communicable disease (NCD) in Europe has created an urgent need for all stakeholders in NCD  prevention to partner together to address the barriers in local health policy and produce effective programs in individual and population risk reduction and rational use of health services.

Major non-communicable diseases - NCDs (cardiovascular disease (CVD), cancer, chronic obstructive pulmonary disease (COPD), and diabetes) are responsible for 85% of the deaths and 70% of the burden of disease in Europe. The costs of managing those diseases create an enormous economic burden for many countries throughout the European Union. The economic situation will further deteriorate in light of the growing prevalence of CVD, the ever-expanding population at risk for future CVD events, the increased life span of individuals in many countries, and the paucity of funding for global disease primary prevention programs to citizens. Skepticism about effectiveness, bureaucratic inertia, and competing interests all contribute to the resistance in preventing NCD diseases and promoting healthy lifestyles. As a result, the health systems of most European countries, and indeed, throughout the world, are not adequately structured or funded to respond to these emerging health care needs. Further, the ongoing worldwide economic crisis is also expected to jeopardize the availability of resources within individual countries for investment in health care systems in both the private and public sectors.
Substantial clinical evidence shows that the clinical and socioeconomic burden of NCD can be markedly attenuated through appropriate integrated approaches to health policies, including individual risk reduction (aimed at high-risk individuals), population risk reduction (aimed at social determinants), the rational use of health services (by empowering primary health care providers), and referral system support (http://www.euro.who.int/document/E91093.pdf). CVD represent both the killer n.1 in many countries and a model where to exercise effective prevention programs. Despite the growing evidence of mortality and morbidity benefits from lifestyle changes, risk factor management, and use of cardio-protective drugs (Eur J Cardiovasc Prev Rehabil 2007; 14 Suppl2:S1-S113), numerous barriers to CVD prevention and management remain to be conquered, both in the individual patient and in the at-risk population as a whole.
The scenario
In Europe, cardiovascular disease (CVD) represents the main cause of morbidity and mortality, costing countries more than €192 billion yearly (2009).
CVD prevention remains unsatisfactory across Europe largely due to:
a)    poor control of CVD risk factors (RFs)
b)    growing incidence of obesity and diabetes, and sedentary lifestyle/poor dietary habits.

Aging of the population, lack of awareness on the differences between genders, inequalities among countries health systems, are complicating the scenario.
Hypercholesterolemia, high blood pressure, smoking, diabetes, overweight/obesity, bad nutrition, lack of physical exercise, stress and social un-satisfaction, air pollution, represent more than 95 % of the risk factors of CVD.
Hypercholesterolemia is a proven modifiable CVD Risk Factors, and LDL-C lowering slows atherosclerotic progression and reduces major coronary events. Lipid-lowering therapy is cost-effective, and intensive treatment of high-risk patients further improves cost effectiveness. In Italy, models indicate that improved cholesterol management translates into potential yearly savings of € 2.9–4 billion.

Identifying and eliminating legislative and administrative barriers is essential to providing optimal lipid care to high-risk patients. Public health and government policy can influence clinical practice rapidly, and guideline endorsement via national health policy may reduce the CVD burden and change physician and patient behavior. Actions to reduce CVD burden should ideally include: a) the integration of strategies to lower the incidence of major CV events,
b) improvement in total CV risk estimation,
c) database monitoring of CVD trends, and
d) development of population educational initiatives on CVD prevention. Failure to bridge the gap between science and health policy, particularly in relation to lipid management, could result in missed opportunities to reverse the burgeoning epidemic of CVD in Europe.

The need
The loss of life, disability, and economic burden attributed to cardiovascular disease (CVD) in Europe has created an urgent need for all stakeholders in CVD prevention to partner together to address the barriers in local health policy and produce effective programs in individual and population risk reduction and rational use of health services.
Legal and moral obligation
Countries have a legal and moral obligation to achieve the highest standard of CV health care for citizens and to improve national health care systems accordingly.
Potential opportunities
As part of a vision for future potential opportunities in CVD prevention, the Lorenzini Foundation would like to raise awareness on several key areas among the European authorities:
a) integration of interventions aimed at several risk factors within an individual country’s health care system;
b) implementation of a comprehensive approach combining policy development, capacity building, partnership and information support at all levels;
c) promotion of transversal health policies, including coordinated action outside of the health sector to address major determinants of ill health;
d) a combination of health policy and high-risk strategies to link health promotion, public health services, primary care, and hospital care;
e) reduction in ethnic, cultural, socioeconomic, and gender inequalities to multiple risk factor management among and within countries through use of cost-effective medications and medical technologies.

February 16, 2010

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