Moving From Political Declaration to Action on Reducing the Global Burden of Cardiovascular Diseases
A Statement From the Global Cardiovascular Disease Taskforce
- AHA Scientific Statements
- cardiovascular diseases
- noncom municable diseases
- Global Cardiovascular Disease Taskforce
- United Nations Political Declaration on Non-communicable Diseases
September 18, 2013, marks 2 years since the monumental meeting of Heads of State at the United Nations in New York to take action against noncommunicable diseases (NCDs), which includes cancer, cardiovascular disease (CVD), diabetes mellitus, and chronic respiratory disease. Recognizing that the rising human and financial costs of NCDs required a profound shift in the way countries viewed development, United Nations member states gathered for the second time in history to address a health concern (the first being the United Nations General Assembly Special Session on HIV/AIDS in 2001). Supporting the United Nations Political Declaration on the Prevention and Control of NCDs, countries acknowledged NCDs as a development issue and made a commitment to address this global crisis by taking action on the major modifiable risk factors— including tobacco use, raised blood pressure, poor nutrition, physical inactivity—triggering the new pandemic of NCDs, as well as the social, economic, and political determinants that shape these lifestyle choices.1 Although the declaration was a political commitment, it was an important first step, bringing together health and development leaders from across the globe to ensure that progress would be made to reduce the burden of NCDs. The past 2 years have witnessed concrete commitments, meaning that our work is only just beginning.
The World Heart Federation and its members spearheaded global advocacy, with other colleagues in the NCD community, calling on the World Health Organization and member states to commit to tangible and achievable goals.2 In 2012, a global target was adopted to reduce premature NCD mortality 25% by 2025—“25by25.”3 Now in 2013, this target, as well as 8 additional targets addressing modifiable risk factors and committing to the use of essential medicines, technologies, and drug therapies to prevent heart attacks and strokes, have been adopted as part of a global monitoring framework and included in the World Health Organization’s Global Action Plan for the Prevention and Control of NCDs (see online-only Appendix for a list of the globally agreed targets and indicators).4,5
These collective decisions taken by governments and ministers of health have ensured that a global architecture is in place that requires governments to be accountable for the actions they take to address NCDs in their countries. This is an extraordinary time of opportunity for the CVD community. As we move from political aspiration to practical application, what role can the CVD community play in developing and implementing a coordinated international strategy of action to attain these fundamental goals for the health of nations?
At the global level, the adoption of this architecture—a global monitoring framework with 9 ambitious targets and 25 indicators—means that governments, for the first time, are accountable for progress on NCDs. These commitments will be translated into action at the national level through strong and cost-effective national plans. Each of our professional organizations will advocate for and offer solutions that can be implemented nationally to address these targets. Systems change is not limited to systems that address health. As the world develops a framework to eradicate poverty and to reassesses the Millennium Development Goals, further progress will depend on recognizing that determinants outside health services affect the health of populations and patients. How people live, move, work, and eat is of paramount importance, and interventions to reduce exposure to modifiable risk factors, as well as address the underlying social determinants, must be planned and implemented now to protect future generations.
The changes we are seeing in models of care in high-income countries toward controlling upstream determinants of NCDs must be expanded. Even the most advanced healthcare systems need to improve how they address primordial and primary prevention through change in population behavior across the life span. Acknowledging that health systems in low- and middle-income countries have been built around infectious disease, these systems must now transform to address CVD morbidity and mortality. Tackling the growing burden of NCDs requires not only a whole of government approach but also a whole of society approach involving nongovernmental organizations, local communities, and industry, where appropriate. The CVD civil society community of heart and stroke foundations and societies across the globe must have a leading role in the implementation of national NCD plans and ensure a focus on CVD primordial, primary, and secondary prevention and rehabilitation. Sharing best practices, aligning measurements, fostering expertise, advancing implementation strategies, and providing leadership are critical and feasible measures to ensure that we achieve the “25by25” target, not only for NCDs, but for CVD as well (Figure6).
The Global Cardiovascular Disease Taskforce—comprising the World Heart Federation, American Heart Association, American College of Cardiology Foundation, European Heart Network, and European Society of Cardiology, and expanded representation from Asia, Africa, and Latin America along with global CVD experts—is helping to sharpen our collective efforts to address CVDs. Working with the World Health Organization, we are assessing and defining those specific metrics for addressing CVD that will be key to achieving the global target of “25by25.” These metrics will extend beyond health systems and will be essential to preventing premature mortality. As CVD organizations operating with and through the World Heart Federation, which itself represents >200 organizations across the globe, and as partners to the World Health Organization, we are committed to the following:
Developing and publishing metrics around the “25by25” target that are specific to CVD and tailored by geography by 2014.
Shaping and supporting inclusion of CVD language in national plans.
Coordinating and aligning efforts around implementation of the CVD-related targets under the “25by25” global target, with a particular focus on reducing tobacco use and hypertension and improving secondary prevention and rehabilitation of CVD.
As we move forward together as professional societies and heart foundations, let us be the global advocates, speaking with one voice, calling for CVD prevention, treatment, and care. We celebrate the Political Declaration of “25by25” and its aspiration to reduce the burden of NCDs, and we now face the challenges of ensuring its reality and ensuring that government plans turn to action to improve the health of all of our populations.
The writing committee members represent the following participating organizations: World Heart Federation (S.C.S., A.C., D.C.), American Heart Association (M.J., R.L.S.), American College of Cardiology Foundation (J.G.H., W.A.Z.), European Heart Network (S.J., S.L.), and European Society of Cardiology (P.E.V., D.A.W.).
The World Heart Federation, American Heart Association, American College of Cardiology Foundation, European Heart Network, and European Society of Cardiology make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.
This document was approved by the World Heart Federation, American Heart Association Science Advisory and Coordinating Committee, American College of Cardiology Foundation Board of Trustees, European Heart Network Board, and European Society of Cardiology Board August 2013.
The American Heart Association requests that this document be cited as follows: Smith SC Jr, Chen D, Collins A, Harold JG, Jessup M, Josephson S, Logstrup S, Sacco RL, Vardas PE, Wood DA, Zoghbi WA. Moving from political declaration to action on reducing the global burden of cardiovascular diseases: a statement from the Global Cardiovascular Disease Taskforce. Circulation. 2013;128:2546–2548.
This article has been copublished in Global Heart, Journal of the American College of Cardiology, and European Heart Journal.
The online-only Appendix is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIR.0b013e3182a93504/-/DC1.
Copies: This document is available on the World Wide Web sites of the World Heart Federation (www.world-heart-federation.org), American Heart Association (my.americanheart.org), American College of Cardiology Foundation (www.cardiosource.org), European Heart Network (www.ehnheart.org), and European Society of Cardiology (www.escardio.org). A copy of the document is available at http://my.americanheart.org/statements by selecting either the “By Topic” link or the “By Publication Date” link. To purchase additional reprints, call 843-216-2533 or e-mail .
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- 1.↵United Nations General Assembly. Resolution adopted by the General Assembly: 66/2: Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. Adopted September 19, 2011; published January 24, 2012.
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- 3.↵World Health Organization. Sixty-Fifth World Health Assembly Resolutions, Decisions, Annexes. WHA65/2012/REC/1. May 21–26, 2012; Geneva, Switzerland. http://apps.who.int/gb/or/e/e_wha65r1.html. Accessed August 11, 2013.
- 4.↵World Health Organization. Draft comprehensive global monitoring framework and targets for the prevention and control of noncommunicable diseases: Formal Meeting of Member States to conclude the work on the comprehensive global monitoring framework, including indicators, and a set of voluntary global targets for the prevention and control of noncommunicable diseases. A/NCD/INF./1. November 5–7, 2012; Geneva, Switzerland. http://apps.who.int/gb/ncds/. Accessed August 11, 2013.
- 5.↵World Health Organization. Sixty-sixth World Health Assembly: Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. WHA66.10, Agenda item 13.1 and 13.2. May 27, 2013; Geneva, Switzerland. http://www.who.int/nmh/events/ncd_action_plan/en/. Accessed August 11, 2013.
- 6.↵World Heart Federation. 25 by 25. http://www.world-heart-federation.org/what-we-do/advocacy/25-by-25/. Accessed August 29, 2013.