BOX 8.8Recommendations

Recommendation 1: Recognize Chronic Diseases as a Development Assistance Priority

Multilateral and bilateral development agencies that do not already do so should explicitly include CVD and related chronic diseases as an area of focus for technical assistance, capacity building, program implementation, impact assessment of development projects, funding, and other areas of activity.

Recommendation 2: Improve Local Data

National and subnational governments should create and maintain health surveillance systems to monitor and more effectively control chronic diseases. Ideally, these systems should report on cause-specific mortality and the primary determinants of CVD. To strengthen existing initiatives, multilateral development agencies and WHO (through, for example, the Health Metrics Network and regional chronic disease network, NCDnet) as well as bilateral public health agencies (such as the CDC in the United States) and bilateral development agencies (such as USAID) should support chronic disease surveillance as part of financial and technical assistance for developing and implementing health information systems. Governments should allocate funds and build capacity for long-term sustainability of disease surveillance that includes chronic diseases.

Recommendation 3: Implement Policies to Promote Cardiovascular Health

To expand current or introduce new population-wide efforts to promote cardiovascular health and to reduce risk for CVD and related chronic diseases, national and subnational governments should adapt and implement evidence-based, effective policies based on local priorities. These policies may include laws, regulations, changes to fiscal policy, and incentives to encourage private-sector alignment. To maximize impact, efforts to introduce policies should be accompanied by sustained health communication campaigns focused on the same targets of intervention as the selected policies.

Recommendation 4: Include Chronic Diseases in Health Systems Strengthening

Current and future efforts to strengthen health systems and health care delivery funded and implemented by multilateral agencies, bilateral public health and development agencies, leading international nongovernmental organizations (NGOs), and national and subnational health authorities should include attention to evidence-based prevention, diagnosis, and management of CVD. This should include developing and evaluating approaches to build local workforce capacity and to implement services for CVD that are integrated with primary health care services, management of chronic infectious diseases, and maternal and child health.

Recommendation 5: Improve National Coordination for Chronic Diseases

National governments should establish a commission that reports to a high-level cabinet authority with the specific aim of coordinating the implementation of efforts to address the needs of chronic care and chronic disease in all policies. This authority should serve as a mechanism for communicating and coordinating among relevant executive agencies (e.g., health, agriculture, education, and transportation) as well as legislative bodies, civil society, the private sector, and foreign development assistance agencies. These commissions should be modeled on current national HIV/AIDS commissions and could be integrated with these commissions where they already exist.

Recommendation 6: Research to Assess What Works in Different Settings

The National Heart, Lung, and Blood Institute (NHLBI) and its partners in the newly created Global Alliance for Chronic Disease, along with other research funders and bilateral public health agencies, should prioritize research to determine what intervention approaches will be most effective and feasible to implement in low and middle income countries, including adaptations based on demonstrated success in high income countries. Using appropriate rigorous evaluation methodologies, this research should be conducted in partnership with local governments, academic and public health researchers, nongovernmental organizations, and communities. This will serve to promote appropriate intervention approaches for local cultural contexts and resource constraints and to strengthen local research capacity.

  1. Implementation research should be a priority in research funding for global chronic disease.
  2. Research support for intervention and implementation research should include explicit funding for economic evaluation.
  3. Research should include assessments of and approaches to improve clinical, public health, and research training programs in both developed and developing countries to ultimately improve the status of global chronic disease training.
  4. Research should involve multiple disciplines, such as agriculture, environment, urban planning, and behavioral and social sciences, through integrated funding sources with research funders in these disciplines. A goal of this multidisciplinary research should be to advance intersectoral evaluation methodologies.
  5. In the interests of developing better models for prevention and care in the United States, U.S. agencies that support research and program implementation should coordinate to evaluate the potential for interventions funded through their global health activities to be adapted and applied in the United States.

Recommendation 7: Disseminate Knowledge and Innovation Among Similar Countries

Regional organizations, such as professional organizations, WHO observatories and chronic disease networks, regional and subregional development banks, and regional political and economic organizations should continue and expand regional mechanisms for reporting on trends in CVD and disseminating successful intervention approaches. These efforts should be supported by leading international NGOs, development and public health agencies, and research funders (including the Global Alliance for Chronic Disease). The goal should be to maximize communication and coordination among countries with similar epidemics, resources, and cultural conditions in order to encourage and standardize evaluation, help determine locally appropriate best practices, encourage innovation, and promote dissemination of knowledge. These mechanisms may include, for example, regional meetings for researchers, program managers, and policy makers; regionally focused publications; and registries of practice-based evidence.

Recommendation 8: Collaborate to Improve Diets

WHO, the World Heart Federation, the International Food and Beverage Association, and the World Economic Forum, in conjunction with select leading international NGOs and select governments from developed and developing countries should coordinate an international effort to develop collaborative strategies to reduce dietary intake of salt, sugar, saturated fats, and transfats in both adults and children. This process should include stakeholders from the public health community and multinational food corporations as well as the food services industry and retailers. This effort should include strategies that take into account local food production and sales.

Recommendation 9: Collaborate to Improve Access to CVD Diagnostics, Medicines, and Technologies

National and subnational governments should lead, negotiate, and implement a plan to reduce the costs of and ensure equitable access to affordable diagnostics, essential medicines, and other preventive and treatment technologies for CVD. This process should involve stakeholders from multilateral and bilateral development agencies; CVD-related professional societies; public and private payers; pharmaceutical, biotechnology, medical device, and information technology companies; and experts on health care systems and financing. Deliberate attention should be given to public–private partnerships and to ensuring appropriate, rational use of these technologies.

Recommendation 10: Advocate for Chronic Diseases as a Funding Priority

Leading international and national NGOs and professional societies related to CVD and other chronic diseases should work together to advocate to private foundations, charities, governmental agencies, and private donors to prioritize funding and other resources for specific initiatives to control the global epidemic of CVD and related chronic diseases. To advocate successfully, these organizations should consider (1) raising awareness about the population health and economic impact and the potential for improved outcomes with health promotion and chronic disease prevention and treatment initiatives, (2) advocating for health promotion and chronic disease prevention policies at national and subnational levels of government, (3) engaging the media about policy priorities related to chronic disease control, and (4) highlighting the importance of translating research into effective individual- and population-level interventions.

Recommendation 11: Define Resource Needs

The Global Alliance for Chronic Disease should commission and coordinate case studies of the CVD financing needs for five to seven countries representing different geographical regions, stages of the CVD epidemic, and stages of development. These studies should require a comprehensive assessment of the future financial and other resource needs within the health, public health, and agricultural systems to prevent and reduce the burden of CVD and related chronic diseases. Several scenarios for different prevention and treatment efforts, training and capacity building efforts, technology choices, and demographic trends should be evaluated. These assessments should explicitly establish the gap between current investments and future investment needs, focusing on how to maximize population health gains. These initial case studies should establish an analytical framework with the goal of expanding beyond the initial pilot countries.

Recommendation 12: Report on Global Progress

WHO should produce and present to the World Health Assembly a biannual World Heart Health Report within the existing framework of reporting mechanisms for its Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases. The goal of this report should be to provide objective data to track progress in the global effort against CVD and to stimulate policy dialog. These efforts should be designed not only for global monitoring but also to build capacity and support planning and evaluation at the national level in low and middle income countries. Financial support should come from the Global Alliance for Chronic Disease, with operational support from the CDC. The reporting process should involve national governments from high, middle, and low income countries; leading international NGOs; industry alliances; and development agencies. An initial goal of this global reporting mechanism should be to develop or select standardized indicators and methods for measurement, leveraging existing instruments where available. These would be recommended to countries, health systems, and prevention programs to maximize the global comparability of the data they collect.

From: 8, Framework for Action

Cover of Promoting Cardiovascular Health in the Developing World
Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health.
Institute of Medicine (US) Committee on Preventing the Global Epidemic of Cardiovascular Disease: Meeting the Challenges in Developing Countries; Fuster V, Kelly BB, editors.
Washington (DC): National Academies Press (US); 2010.
Copyright © 2010, National Academy of Sciences.

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