MDGs: From heart disease to poverty reduction

By Kola Akinroye

The United Nations Millennium Development Goals (MDGs) are designed to reduce poverty in developing countries by the year 2015. Health is central to the achievement of the MDGs and three goals are explicitly targeted at health issues: to reduce child mortality; to improve maternal mortality; and to prevent the spread of HIV/AIDS, malaria and other diseases.

The health goals of the MDGs are too narrowly defined with attention on the plight of the world’s poorest children and mothers, and on some infectious disease epidemics. However, heart disease (a chronic disease) which affect the majority of the world’s population especially developing countries has not been included within the global targets.

Of the 58 million deaths in the world in 2005, heart disease was the leading cause of death with a mortality of 17.5 million (80% of this death occurred in developing countries). In contrast, the infectious diseases targeted in the MDGs caused 2.8 million deaths from HIV/AIDS, 1.6 million from tuberculosis, and 0.8 million from malaria. Thus, heart disease caused 3.3 times more deaths than infectious disease combined.

In spite of this distressing data little global attention is being paid to the challenge of reducing this burden in developing countries.

Poverty increases the risk of developing heart disease. and also increases the chances of developing complications and dying prematurely. Heart disease in developing countries, largely through the combined effects of tobacco, unhealthy diets, physical inactivity and overweight strikes the younger working age people that portend a negative impact on economic growth. By adulthood, overweight children are 3 to 5 times more likely to suffer a premature heart attack than are children of normal weight.

Heart disease inflicts an enormous direct or indirect economic burden on the poor, and pushes many people and their families into poverty. Acute events like heart attack or stroke- can be ruinously expensive. and are indeed so for millions of people in the developing countries. People who fall ill often face a dire choice: either to suffer and perhaps die without treatment, or seek treatment and push their family into poverty. Those who suffer from long- standing heart disease are in the worst situation because the costs of expensive medical care are incurred over a long period of time.

It is instructive to take a cursory look at six programmes and initiatives that have made significant impacts on heart disease prevention and control in global populations.

First, community-based programmes have proven potential as an approach to heart disease control. A typical example is the North Karelia Project in Finland, launched in 1972 as a community- based programme that influenced diet, blood pressure and physical activity; factors which are essential in the prevention and control of heart disease. Evaluation showed how the diet (particularly fat consumption) changed and led to a major reduction in population blood cholesterol and blood pressure levels in Finland.

Second, work site/employer based health programmes are cost-effective for the employer and are most effective when they include the establishment of an infrastructure that promotes health education, professional training, detection and management of high blood pressure patients, dietary counseling (including a focus on salt intake and reducing overweight), quitting smoking and restricting alcohol.

Third, the W.H.O. Global Strategy for Diet, Physical Activity and Health, which provides a framework for multistakeholder interventions to promote increased physical activity and healthier diets. Similarly, the National Heart Foundations Food Labeling programmes that promote heart-friendly foods have proven to be useful in modifying fat and salt intake in populations.

Fourth, the Framework Convention on Tobacco Control ( FCTC), the world’s first global treaty, ratified by 168 countries provides govemments, the medical profession, non-governmental organizations with suggested policies and programmes for reducing tobacco use. Its provision has proved to be effective.

Fifth, awareness-building efforts such as the World Heart Day and the Go Red for Women Campaign (designed to raise awareness among women of their risk of heart disease) are cost - effective means to educate populations. These programmes could be adopted at state and local governments levels

Sixth, professional organizations and non-governmental organizations should collaborate and adapt international management guidelines to meet the real needs of patients. .Such associations should lead the health promotion activities and education efforts for the primary care physicians. Drugs that are affordable, effective and locally manufactured should be promoted.

With the current evidence that heart disease causes three times more deaths than infectious diseases (HIV/AIDS and Malaria) combined, urgent action is needed to adapt for our own purpose MDG6 to read “combat infectious disease such as HIV/AIDS and Malaria, along with heart disease using an integrated approach” for effective achievement of poverty reduction.

Dr. Akinroye is the Executive Director, Nigerian Heart Foundation