This article is part of our special report Cardiovascular health in the UK.
Death from cardiovascular diseases (CVD) may have fallen substantially in the UK and across the world, but it remains the single biggest killer, and a sizeable economic burden.
The deaths of 550,000 working-age people across European Union countries from chronic diseases, including heart attacks, strokes, diabetes and cancer, cost EU economies €115 billion, equivalent to 0.8% of GDP annually. This figure does not include the additional loss in terms of lower employment rates and productivity of people living with chronic health problems.
The UK sits in the middle of the European pack, according to the ‘Health at a Glance’ report published by the Paris-based Organisation for Economic Co-operation and Development (OECD) in late November. More than 55,000 Britons die prematurely from ‘non-communicable’ diseases such as CVD each year – a rate of 166 deaths per 100,000 – compared to an EU average of 201 deaths per 100,000.
The charity Heart UK reckons that CVD costs the economy £19 billion (€22.5bn) per year, of which 46% are direct healthcare costs, 34% in productivity losses and 20% informal care of people with CVD.
Addressing the root causes
Unhealthy eating, smoking and alcohol consumption contribute to the development of cardiovascular diseases and will cost an estimated $30 trillion in lost economic output and treatment costs over the next 20 years, according to the World Economic Forum.
Last week, cardiovascular disease was at the top of the agenda of the World Innovation Summit for Health’s (WISH) two-day conference in Doha on global healthcare challenges.
“This year, we have cardiovascular disease, because it is the number one killer in the world. About one-third of deaths worldwide occur as the result of either stroke or heart attack, and this is especially prevalent in rapidly developing countries,” WISH Chief Executive Egbert Schillings said.
For his part, Lord Darzi, a surgeon and former UK government health minister, believes that policymakers have failed to make CVD prevention a major focus of their attention.
“If behavioural and lifestyle factors increasingly drive the majority of years of healthy life lost, then isn’t it time we attack these issues at their causal roots, not just the symptoms?” Lord Darzi asks.
Darzi’s position appears to be backed by the National Institute for Health and Care Excellence (NICE). Its latest guidance on combating cardiovascular disease, issued in September, suggest that adults with a 10-year risk of CVD of 10% or more should be given advice on lifestyle changes before being offered any statin therapy.
Public health investment repaid
The UK government’s approach to tackling the burden of CVD is based around its NHS (National Health Service) Health Check programme, introduced in 2009, and which offers screening for all healthy adults aged 40 to 74 for CVD risk, and treatment of those at high risk.
However, debate about the scientific foundation and effectiveness of a universal policy approach has been heated recently, following substantial socioeconomic inequalities observed in CVD mortality in England.
In England, people living in the most deprived 20% of neighbourhoods are around two and a half times more likely to be admitted to an emergency ward as the wealthiest 20%, according to the Centre for Health Economics.
These inequalities also reflect much greater premature mortality, and shorter life expectancy, among the most deprived groups. Despite the controversy, the programme remains policy.
Real terms cuts to healthcare spending across the EU are putting strain on primary care, but former US Treasury Secretary Larry Summers argued last week in Doha that increased government and private-sector investment would be quickly repaid.
“If local resources are sufficient to meet national challenges in most countries, and if substantial extra resources become available, that suggests one should work on global investment in healthcare,” said the professor and president emeritus of Harvard University in his keynote speech.
The number one killer in Europe, cardiovascular disease, is set to become an even greater burden on the already recession-hit continent's health systems.
Cardiovascular disease accounts for 52% of female deaths and 42% of male deaths in the EU. Approximately four million people in Europe and 1.9 million people in the EU die of cardiovascular disease each year, according to the European Society of Cardiology. Cardiovascular disease and strokes are usually caused by high levels of bad cholesterol, high blood pressure, obesity, unhealthy diet and physical inactivity.
The European Society for Cardiology (ESC) and the European Heart Network (EHN) estimate the cost to the EU economy at over €196 billion per year, with healthcare expenditure varying from 4% in Luxembourg to 17% in Estonia, Latvia and Poland.
To reduce the number of deaths from heart diseases, EU countries agreed in November 2013 to tackle the underlying health determinants behind cardiovascular disease in the common health programme for 2014-2020 through “promoting health, preventing diseases and fostering supportive environments for healthy lifestyles”.
The EU wants cost-effective prevention measures for addressing tobacco, alcohol, and unhealthy dietary habits. It also aims to promote physical activity among EU citizens.
Sanofi have provided the funding for this report. Sanofi have had no editorial input or involvement in the content of this report.