Developing a Strategy for Cardiovascular Disease: Surveillance,Prevention and Healthcare.

Abstract

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. 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. 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. 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.