Making the Case for Healthier Hearts in the Developing World

I’d be willing to bet that nary a H8 meeting (if you have to ask….) has included a discussion on the impact of heart disease, obesity, or diabetes in developing countries. Yet chronic diseases, particularly cardiovascular disease (CVD), have emerged as a significant—and growing—threat to those living in poor countries.Yesterday, the U.S. Institute of Medicine released an early version of a report entitled Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. The report details governments, global health institutions, and development agencies’ lack of attention to CVD and offers recommendations to better prevent and control the disease.As a member of the IOM committee that produced the report, I learned a great deal from the cardiologists and diabetes docs who were my colleagues on the committee. I think what they learned from me is that silver bullet solutions to CVD in poor countries remain elusive to clinicians and economists alike. While the economic impacts of CVD are alarming, changing global health priorities and funding streams is a hard task and it’s not yet clear what it will take to convince the H8 or others to play a role in attacking the problem, rather than continue to leave it to developing country governments and households on their own.CVD is a critical health challenge in low and middle income countries, causing nearly 30 percent of deaths each year (the largest single contributor), and has particularly significant economic ramifications. CVD is increasing, while infectious diseases are dropping in almost every developing country. At the same time, almost all health institutions, governments, and development agencies have ignored CVD as a global health priority for developing countries. Two simple points make the case:

• Chronic diseases are the least funded area of donor assistance for health. Forthcoming CGD analysis shows that only 2.3 percent of the $22 billion per year in international donor assistance in health is devoted to CVD and other chronic diseases, while chronic diseases contribute 69 percent of deaths.
• There is NO global development target for chronic diseases; therefore, no donor has to feel (or look) bad if the trend of chronic disease mortality continues to rise.

The IOM report also offers plenty of reasons why official aid agencies should worry about the impact of chronic diseases on development. For one, the report finds that poverty is both a cause and a consequence of CVD. The poor are more likely to be exposed to CVD risks than their wealthier counterparts. CVD and other chronic diseases impede household productivity and savings, thereby pushing people into poverty.Whether you live in the U.S. or in a developing country, it’s not easy to live “heart healthy”. Without more attention to chronic diseases such as CVD, developing countries will face an ever-growing health and economic burden from these (largely preventable) illnesses. Another recent news item provides some encouragement. This week PepsiCo announced that it will revamp many of its food and beverage products to reduce sugar, salt, and transfats. Perhaps official health agencies will eventually follow the leadership emanating from the private sector.