Source: http://www.economistinsights.com/healthcare/opinion/heart-darkness%E2%80%94fighting-cvd-all-mind
CVD prevention at population level, such as a “fat tax” or smoking ban, relies heavily on regulation. This is its greatest strength – it can compel healthy behaviour (or seat belt wearing) – but also its greatest potential weakness. It inevitably involves some degree of coercion, which runs the risk of paternalism.It need not involve regulation, however. The same human flaws that are exploited by the food industry to persuade us to buy certain items at the check-out can also be used to persuade us to act in the interests of our own health. The current UK government is attempting to turn psychological weakness into an advantage outside of the legislative framework.
Its Behavioural Insights Team, commonly referred to as the “nudge unit”, is designed to seek “intelligent ways” to support and enable people to make better choices, using insights from behavioural science and medicine instead of increased rulemaking. Many of these goals overlap with CVD prevention, from smoking cessation to encouraging kids to eat healthier foods and walk to school more often. Early successes have brought them to the attention of the Obama administration in the US.
Besides the difficulties of making positive lifestyle changes, non-adherence to treatment is another significant obstacle to effective CVD prevention. Even after suffering a CVD incident, some patients forget to take their medication; other patients opt not to complete a course of treatment for other reasons, ranging from concerns about costs, the inconvenience involved with travel, to feelings of despondency caused by depression and anxiety. At its most anodyne, individuals frequently stop taking drugs prescribed for prevention after they feel better and think themselves cured.
This is part of a much wider medical problem: in the rich world adherence to treatment for all diseases is around 50%. Recognising the commercial opportunities here, private enterprise is looking to play a greater role. Earlier this year a US company called WellDoc launched a smartphone product aimed at giving type 2 diabetics better management of their treatment, through tailoured advice and motivational coaching. In the UK, meanwhile, a start-up calledImpact Health is developing a similar health psychology smartphone product to increase adherence to treatment among sufferers of Crohn’s disease.
CVD patients stand to benefit from such development in medical technology, although they may have to wait a little while yet. Impact Health’s online platform requires patients to have a smartphone. For this reason the start-up is targeting Crohn’s first and not CVD. As David Knull, one of its directors, explains, the profile of the average sufferer is generally around 30 years old—far younger than the average CVD patient, and much more likely to have a smartphone.
Report source: http://www.economistinsights.com/healthcare/analysis/heart-matter
Report PDF: The heart of the matter – Rethinking prevention of cardiovascular disease
The heart of the matter: Rethinking prevention of cardiovascular disease is an Economist Intelligence Unit report, sponsored by AstraZeneca. It investigates the health challenges posed by cardiovascular disease (CVD) in the developed and the developing world, and examines the need for a fresh look at prevention.
The report is also available to download in German, French, Italian, Spanish, Portuguese (Brazilian) and Mandarin—see the Multimedia tab
Why read this report
- Cardiovascular disease (CVD) is the world’s leading killer. It accounted for 30% of deaths around the globe in 2010 at an estimated total economic cost of over US$850bn
- The common feature of the disease across the world is its disproportionate impact on individuals from lower socio-economic groups
- Prevention could greatly reduce the spread of CVD: reduced smoking rates, improved diets and other primary prevention efforts are responsible for at least half of the reduction in CVD in developed countries in recent decades…
- …but prevention is little used. Governments devote only a small proportion of health spending to prevention of diseases of any kind—typically 3% in developed countries
- Population-wide measures like smoking bans and “fat taxes” yield significant results but require political adeptness to succeed. There is no shortcut for the slow work of changing hearts and minds
- The size of the CVD epidemic is such that a doctor-centred health system will not be able to cope. Innovative ways for nurses and non-medical personnel to provide preventative services are needed
- A growing number of stakeholders are involved in CVD prevention, sharing the burden with governments. Now, greater collaboration across different sectors and interest groups should be encouraged
- Collaboration works when incentives of stakeholders are aligned, including business. Finland’s famed North Karelia project suggests better alignment of interests is crucial to a successful “multi-sectoral” approach
Cardiovascular disease is the dominant epidemic of the 21st century. Dr Srinath Reddy, president of the World Heart Federation
We know a lot about what needs to be done, it just doesn’t get done. Beatriz Champagne, executive director of the InterAmerican Heart Foundation
Action at the country level will decide the future of the cardiovascular epidemic. Dr Shanthi Mendis, director ad interim, management of non-communicable diseases, WHO