The past two years have put our healthcare systems in Europe to the test, as the COVID-19 pandemic brought an added setback on top of the public health challenges that countries were already facing.
Each wave of COVID has brought new challenges to systems struggling with stretched services. System pressures have distracted Member States from their core health priorities, including diagnosis and management of chronic disease. Europe’s #1 cause of death is cardiovascular disease (CVD), and attention has been diverted through the COVID crisis. This is despite the fact that CVD is a clear predictor of poorer outcomes for people impacted by COVID, but also that COVID has significant cardiovascular impacts.
Today, CVD causes 37% of all deaths in the EU. CVD impacts the lives of 60 million Europeans. It is Europe’s leading cause of death in people under 65. As the ageing of Europe’s population progresses, we would expect these figures to increase further unless new and decisive actions are taken by public health authorities.
For policymakers this should be a cause of great concern – both for population health and its effect on health systems. CVD costs the EU 210 billion Euros every year, including the direct costs of healthcare, and also the considerable productivity losses of people prematurely leaving the workforce, and the indirect costs of caregiver support.
Despite ranking as Europe’s #1 killer, efforts to prevent and treat CVD lag behind other diseases. CVD-focused public health information and actions to raise awareness are lower than for other conditions. Despite the high impact of CVD, there is low public awareness of its risks. This is in stark contrast to cancer – Europe’s #2 cause of death. Here, stakeholders have access to a wealth of information on cancer diagnosis, prevention, and cure. Today most EU countries have cancer initiatives, including screening programs in breast, cervical and colorectal cancer. Very few have national cardiovascular strategies.
The Beating Cancer Plan is inspiring – but heart disease needs are fundamentally different
The Beating Cancer Plan (BCP) gives Europe an excellent starting point to show that solidarity against our most prevalent conditions can galvanise society to act. Some factors that prevent non-communicable diseases (NCDs) are relevant to both cancer and CVD – for example stopping smoking, reducing sugars and salts, and increased physical activity. But for CVD, these are the tip of the iceberg. CVD is often present in parallel with other chronic conditions, including obesity, diabetes, and hypertension. The parallel risk of combined conditions leads to greatly increased risks of compromised health or premature death. An effective ‘Beating CVD’ plan for Europe should embrace a focused approach, ensuring that appropriate identification, management and treatment is the mainstay of those living with CVD and related conditions.
Towards a galvanized European CVD community
2021 saw the launch of new initiatives calling to reduce cardiovascular disease burden. For example, the European Alliance for Cardiovascular Health (EACH) is calling on EU policymakers to develop an EU CVD Plan.
Also in 2021, a session at the European Health Forum Gastein assessed how to progress toward a ‘Beating CVD’ plan for Europe. This group of leading experts discussed the elements of a Europe-wide CVD plan. Key issues highlighted by these experts were:
- Healthcare systems need to shift their focus from reactive to prevention first, then cure.
- Education and awareness will make a difference; CVD is deadlier than cancer but people fear it less.
- EU-level CVD policies can inform people to make healthy lifestyle choices.
- Investments in research, development and new technologies are vital to reducing CVD-related mortality.
Likewise, the WHO Global Action Plan for the Prevention and Control of Non-Communicable Diseases (NCD-GAP) directly supports the conceptual basis for a focused CVD plan. However, in 2021 a mid-term evaluation of the Plan was reported to the 74th World Health Assembly, identifying major limitations, and made recommendations to place Member States on a sustainable path to achieve their Sustainable Development Goal (SDG) target 3.4.1 by 2030.
Recently the European Commission announced plans to undertake an extended NCD initiative – Healthier Together. It will cover the period 2022-2027 and include five strands: cardiovascular diseases, diabetes, chronic respiratory diseases, mental health and neurological disorders, and a horizontal strand on health determinants.
The Healthier Together initiative has been welcomed by the health community. What is clear, when reflecting on the NCD-GAP mid-term review, is that without clear and focused attention on specific aspects of NCD management, target achievement may be compromised. The strengths of the BCP are that a clear political commitment has been made to leave no stone unturned to address cancer. The BCP itself notes that it contains “concrete, ambitious actions that will support, coordinate and complement Member State efforts to reduce the suffering caused by cancer”. The same approach should be undertaken within the Healthier Together initiative to ensure that clear and focused attention can be provided across the other key NCDs that impact the health of Europeans.
Reducing the risk of CVD for Europe’s population is within our reach and COVID has driven the urgency to act. Initiatives such as Healthier Together give a measure of hope that progress can be made. But, to achieve success these initiatives require political commitment and strong intersectoral partnerships that facilitate genuine progress towards SDG targets, which further strengthens our health systems for people living with (or at risk of) CVD. In the words of a Gastein expert: “It’s incredible that this needs to be said at all; but the number one cause of death deserves policy attention”.