SEATTLE — The eight existing post-2015 Millennium Development Goals (MDGs) have helped the world gauge its progress in alleviating global poverty. We have nearly cut world hunger in half, yet there exists seven MDGs that remain unreached. Moreover, there is a significant global health issue that remains unmentioned. The sixth Millennium Development Goal focused on halting and reversing the spread of the communicable diseases HIV/AIDS and malaria; however, no MDG specifically addressed the growing risk and severity of various types of noncommunicable diseases—namely, the most prominent and fatal: cardiovascular disease. The new Sustainable Development Goals (SDGs) seek to revalidate and regroup unreached MDGs and address new global health issues, but fail to give cardiovascular disease sufficient attention. The third SDG, which seeks to “ensure healthy lives and promote wellbeing for all at all ages,” contains a subsection that groups communicable and noncommunicable diseases together in the context of the research and development of methods and vaccines. As the United Nations narrowed its communicable disease focus on two specific epidemics in the MDGs, the United Nations must adopt the specific SDG of reducing the burden of cardiovascular disease before adopting the broad and general resolution of combating noncommunicable diseases (NCDs).
On a global scale, cardiovascular disease poses substantial health and financial threats to a disproportionate number of people. Although most heart disease and strokes are preventable, cardiovascular disease is the number one cause of death globally and the leading killer of women in the world, comprising a shocking one-third of all female deaths worldwide. In 2008, cardiovascular disease was 30% of all global deaths—7.3 million due to coronary heart disease and 6.2 million due to stroke. Like other NCDs, cardiovascular disease is a growing epidemic that transcends race, socioeconomic status and country of origin.
To provide more of a focus, low- and middle-income countries are disproportionately affected, as over 80% of cardiovascular disease deaths occur in developing countries. In 1990, cardiovascular disease accounted for 108,802 DALYs lost in developing regions. This indicates that the contribution of developing countries to the global burden of cardiovascular disease was 2.8 times higher than that of developed countries. Compared to 26.5% in developed countries, the portion of cardiovascular deaths occurring below the age of 70 years was a striking 46.7% in developing countries.
The high prevalence of cardiovascular deaths in low- and middle-income countries also has financial implications. The World Health Organization (WHO) estimated that the projected lost output from 2011-2025 associated with cardiovascular disease in low- and middle-income countries is $3.76 trillion. Because of inadequate food and resources, as well as weak healthcare and political systems, many developing nations lack the necessary skills to prevent and detect cardiovascular disease in their populations.
There exists an obvious connection between cardiovascular disease prevalence, the health of the general population and economic instability. A population that is crippled by heart disease, strokes or other cardiovascular issues cannot positively contribute to the political or economic sectors of a country. The productivity of a country takes an enormous toll because as the mortality rate rises, the number of employed citizens decreases.
In addition, the economic burden on the healthcare system causes inordinate increases in government expenses and taxes. Dr. K. Srinath Reddy, MD, DM, Professor of Cardiology at the Cardiothoracic Centre in All India Institute of Medical Sciences, indicated that “nations that must invest their scarce resources in programs of industrial growth and sustainable development may ill afford the escalated health care expenditure imposed by the technology intensive management of manifest CVD.” Such devastating diseases create an enormous economic burden on countries already suffering from low productivity and financial instability; thus, the societal, political and financial need for reducing the risk of cardiovascular disease is astronomically important for developing countries.
A reduction in the burden of cardiovascular disease necessitates addressing various risk factors, including tobacco use, unequal access to fruits and vegetables, obesity, and the lack of physical activity and stress relief practices. Countries also must improve access to mental health and counseling centers.
Reducing cardiovascular disease is a realistic goal for which public health officials and members of the WHO have consistently campaigned. The sheer size of this epidemic is predicted to cost the world economy—both developed and developing countries alike—over $47 trillion over the next 20 years, accounting for 75% of the global gross domestic product. Countries clearly have a financial incentive to prioritize the reduction of cardiovascular deaths, but ensuring that healthcare systems shift their focus to the epidemiological reality, so as not to exclude NCDs like cardiovascular disease from overall disease reduction, will be a welcome challenge.
– Paulina Menichiello