Heart healthy environments: A call for action

Dr Amitava Acharyya, CNS Correspondent, India
Cardiovascular diseases (CVD) are the world’s number one killer. The World Health Organization (WHO) estimates that CVDs accounted for 31% of all global deaths in 2012, killing 17.5 million people. Of these deaths attributable to CVDs, more than 75% took place in low- and middle-income countries (LMIC).

By 2030, researchers project that non-communicable diseases (NCDs) will account for more than three quarters of deaths worldwide and CVDs alone will be responsible for more deaths (23 million deaths) in low income countries than infectious diseases (including HIV/AIDS, TB, and malaria), maternal and perinatal conditions, and nutritional disorders combined. Thus, CVD is today’s largest single contributor to global mortality and will continue to dominate mortality trends in the future, if not taken heed of.

World Heart Day is celebrated globally on 29th September with the intent of raising awareness of cardiovascular disease. Each year has a different theme which tackles different aspects of heart disease. This year’s theme was developing ‘heart-healthy environments’.

The ‘heart healthy environment’ is a unique combination of activities, which prevent the modifiable risk factors of heart diseases. They mainly address few actions in a well formed manner, which are easily acceptable and applicable throughout the world in primordial and primary prevention aspect. Live, Work and Play are three areas they have proposed to intervene in individual and community level.

 World Heart Federation (WHF) proposes different ‘in house’ activities, which can prevent the onset of heart diseases, like—‘Stock your home with healthy food options’, ‘Ban smoking in your home’, ‘Be active’, and ‘Recognize your CVD risk’. Thus there is a stress on healthy food eating behaviour, smoke free homes, physical activities and periodical medical check ups.

 There are opportunities for bringing the epidemic of heart diseases and stroke under control by tackling the problem at the workplace, where a significant number of people spend about a third of any given day. Many studies have shown that maintaining healthy workplace can lower direct as well as indirect costs, by improving employee productivity and decreasing absenteeism. The ‘heart-healthy environment’ addresses this exclusive preventive aspect of heart diseases. It has focused on the stress and smoke free working environment with much more emphasis on utilization of time spaces with any type of physical activity.

 WHF has advised, in their ‘Heart-Healthy Environment’ campaign, to involve any type of physical activity in day to day life. According to the World Health Organization, children aged 5-17 years of age should aim for at least 60 minutes of moderate to vigorous intensive physical activity every day, while adults must continue 50 minutes of moderate aerobic exercise throughout the week. WHF has preferred brisk walking, jogging, swimming and cycling as ideal aerobic exercises.

 Dr Angela Jackson Morris of the International Union Against Tuberculosis and Lung Disease (The Union) also calls for tackling tobacco use, which is the leading risk factor for CVD after hypertension (which is also worsened by smoking). An estimated 10% of all cardiovascular diseases globally are caused by smoking and so could be prevented entirely. Chewing tobacco also increases risk of CVD. Moreover non-smokers (adults and children) who breathe secondhand smoke are 25-30% more likely to develop CVD. Morris urges action at various levels to address this critical issue:

Government--enforce smoking ban in public places, ban tobacco sales/advertising, increase tobacco taxation, and promote heart health through mass media campaigns

Healthcare professionals-- enure that healthcare environments are 100% smokefree, and discuss smoking with every patient and offer cessation support help smokers quit

Employers-- ensure smoke free workplaces and incentivise staff to quit

Communities-- ensure smoke free indoor public places and encourage smoke free outdoor spaces

Individuals-- quit to protect themselves and also their family (from second hand smoke).

The government of India had launched various initiatives for prevention of heart diseases and stroke. The pilot of National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) has already been completed. At the school level congenital heart disease screening programme has been initiated in few states of India such as West Bengal, but much more awareness generation programmes are needed to bring about a positive change in habits at individual and community level. The time is ripe to develop plan and programmes for prevention of heart diseases through different interventions at the work places in the public as well as private sector.

Dr Amitava Acharyya, Citizen News Service - CNS
October 17, 2015