Even as cardiovascular diseases (CVDs) such as stroke, diabetes and hypertension are claiming millions of people prematurely every year, most healthcare facilities in many Low-and Middle-income Countries (LMICs) are unprepared to treat such patients, says a study. It comes as a wakeup call for India which is already facing burgeoning CVDs epidemic, reports ARCHANA JYOTI
Globally, nearly 18 million premature deaths in 2019 were due to CVD, of which 75 per cent were in LMICs, where they are leading causes of death and Disability Adjusted Life Years (DALYs) in adults. Diabetes and hypertension are key risk factors for CVD and amongst the top three risk factors for deaths and disability, globally.
Publishing their findings recently in PLOS Global Public Health, an international team of researchers led by the University of Birmingham, looked at readiness to provide care for HIV or CVD in Afghanistan, Bangladesh, Democratic Republic of Congo (DRC), Haiti, Malawi, Nepal, Senegal, and Tanzania.
They discovered that most facilities are unprepared to deliver services to treat or manage cardiovascular disease risk factors (CVDRF) such as diabetes and hypertension.
However, the increased investment in facilities to treat HIV – received as part of the drive to meet UN Millennium Development Goal (MDG) targets – may form part of a solution to tackle CVDRFs, which have been relatively neglected in terms of receiving global funding and attention. The study authors found that if facilities are able to provide HIV care, they are much more able to supply care for CVDRFs.
They found that despite UN targets to reduce CVDRF, facilities were significantly less ready to provide CVDRF care than HIV care, even though despite years of investment in HIV, facilities were often not ready to fully provide care for HIV.
Lead author Professor Justine Davies, from the University of Birmingham, commented: “We’ve had global targets to reduce burden of CVDRFs since 2011, but tackling the problem requires healthcare services to have all the ingredients to care for patients – including staff, facilities, medicines, or equipment.
“Given the long-term financial investment and advocacy for HIV, we looked to see what readiness to provide care could be achieved with good long-term investment. We then compared readiness for CVD care with that of HIV care. We found that, despite years of investment in HIV, facilities were often not ready to fully provide care. But we found that the situation for CVD was far worse.”
Neil Cockburn, another lead author on the paper from the University of Birmingham, commented: “There needs to be a large scale up of investment to ensure facilities are ready to provide healthcare for people with CVDRF if global targets are to be met.
“Our findings provide policy makers, funders, and researchers evidence of where there are gaps in service provision which need to be filled to enable achievement of current global health goals.”
The researchers found that in individual countries, readiness across all healthcare facilities to handle CVDRF was generally lower than for HIV. There were consistently weaknesses in information, staffing and medicines. Lack of readiness of facilities to provide CVDRF care in rural and primary care facilities threatens SDG 3.8 to provide high quality universal healthcare for all.
According to health experts, high blood pressure, air pollution, tobacco use, and elevated LDL cholesterol are among the leading contributors to CVD deaths.
Yet another study published in PLOS One, has called for a multifaceted approach to prevention that includes fiscal, inter-sectoral, public health and health-service level interventions at all—primordial, primary, secondary as well as tertiary—levels.
“Several interventions have already been tested in various low-to-middle income countries and have shown to improve the CVD burden in a cost-effective manner. For example, the Disease Control Priorities report of the World Bank enlists an essential package of interventions that can prove beneficial,” say the authors.
“ Some of the interventions enlisted include taxation on tobacco and sugar-sweetened beverages, regulations on processed and salt-rich food, ban on trans-fatty acids, improvements in built environment and introduction of school health programs to encourage physical activity, task-sharing or task shifting in cardiac care, improving screening activities and better use of combination therapy.”
In India too, the situation is grim. The Asian Pacific Society of Cardiology (APSC) recently published a report revealing that heart failure alone leads to 1.8 million hospitalisations each year in India.
Experts have been calling to tighten the noose around the companies marketing highly processed food which are mostly responsible for a spike in CVD with kids also being impacted.
For instance, a report, titled ‘THE JUNK PUSH: Rising Ultra-processed Food Consumption in India — Policy, Politics and Reality’, has recommended stronger policies to protect children from the harmful impact of food marketing.
Most of the products analysed as part of the study are widely consumed brands mainly targeted at children. These included packaged products high in fat, sugar and salt (HFSS) or ultra-processed foods (UPF), such as chips, cookies, sweets, soft beverages, instant noodles, sugary cereals, frozen meals, ice cream, bakery items, and chocolates.
According to the document, their advertisements were found to be in violation of the Consumer Protection Act, 2019, with some of them even violating the Food Standard and Safety Act, 2006, as they hid crucial information related to nutrients of concern.
“None of the legal frameworks or guidelines in India has the potential to stop most of the misleading advertisements of prepackaged junk or HFSS foods, or to ban misleading claims or warn people about the risks to health,” said Dr Arun Gupta from Delhi-based nutrition think tank Nutrition Advocacy in Public Interest (NAPi) which has prepared the report.
He said that cardiovascular disease risk factors starting in childhood have important implications for health, quality of life, health care costs and societal costs across the whole life course. Facing challenges with resources, it is time to work on prevention rather than waiting to be cured, Dr Gupta said matter-of-factly.