Bridget B. Kelly

Global Cardiovascular Health: Urgent Need for an Intersectoral Approach

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with more than 80% of CVD deaths occurring in low- and middle-income countries (LMICs). There have been several calls for action to address the global burden of CVD, but there remains insufficient investment in and implementation of CVD prevention and disease management efforts in LMICs. To catalyze the action needed to control global CVD, the Institute of Medicine recently produced a report, Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. This paper presents a commentary of the Institute of Medicines report, focusing specifically on the intersectoral nature of intervention approaches required to promote global cardiovascular health. We describe 3 primary domains of intervention to control global CVD: 1) policy approaches; 2) health communication programs; and 3) healthcare delivery interventions. We argue that the intersectoral nature of global CVD interventions should ideally occur at 2 levels: first, all 3 domains of intervention must be activated and engaged simultaneously, rather than only 1 domain at a time; and second, within each domain, a synergistic combination of interventions must be implemented. A diversity of public and private sector actors, representing multiple sectors such as health, agriculture, urban planning, transportation, finance, broadcasting, education, and the food and pharmaceutical industries, will be required to collaborate for policies, programs, and interventions to be optimally aligned. Improved control of global CVD is eminently possible but requires an intersectoral approach involving a diversity of actors and stakeholders.

Recognizing Global Burden of Cardiovascular Disease and Related Chronic Diseases

Cardiovascular disease is the leading cause of death worldwide, affecting not only high-income but also low- and middle-income countries. Nearly 80 percent of all estimated cardiovascular disease-related deaths worldwide now occur in low- and middle-income countries, where nearly 30 percent of all deaths are attributable to cardiovascular disease. The health burden of cardiovascular disease and other chronic diseases is also accompanied by a significant deleterious economic impact at the level of both national economies and households. The global trends in the health and economic burden of cardiovascular disease provide a compelling argument in support of prioritizing urgent yet carefully planned efforts to prevent and control cardiovascular disease worldwide-and especially in low- and middle-income countries. After decades of escalating efforts to draw attention to the high burden of cardiovascular disease and other chronic diseases, this critically important issue is now emerging as a more central part of the global health and development agenda. The breadth of behavioral, biological, social, environmental, and systems-level factors that contribute to cardiovascular disease necessitates multisectoral approaches across the lifecourse that promote healthful lifestyles, reduce risk, and reduce cardiovascular-disease morbidity and mortality through the delivery of quality health care services. Given that the complex interactions among the determinants of cardiovascular disease vary in different contexts, real progress in control efforts will come through approaches that are driven by a countrys disease burden and risk profile, capacities, resources, and priorities-approaches that are led by a countrys key decision-makers and stakeholders, including governments, civil society, the private sector, and communities. Many countries are already establishing efforts to address chronic diseases. In addition to these locally driven efforts, success will require active engagement and sustained action from a wide array of stakeholders operating at global and regional levels.

Transforming the Workforce for Children Birth Through Age 8

Children are already learning at birth, and they develop and learn at a rapid pace in their early years. This provides a critical foundation for lifelong progress, and the adults who provide for the care and the education of young children bear a great responsibility for their health, development, and learning. Despite the fact that they share the same objective - to nurture young children and secure their future success - the various practitioners who contribute to the care and the education of children from birth through age eight are not acknowledged as a workforce unified by the common knowledge and competencies needed to do their jobs well. This book explores the science of child development, particularly looking at implications for the professionals who work with children. The book examines the current capacities and practices of the workforce, the settings in which they work, the policies and infrastructure that set qualifications and provide professional learning, and the government agencies and other funders who support and oversee these systems. The book then makes recommendations to improve the quality of professional practice and the practice environment for care and education professionals. These detailed recommendations create a blueprint for action that builds on a unifying foundation of child development and early learning, shared knowledge and competencies for care and education professionals, and principles for effective professional learning. Young children thrive and learn best when they have secure, positive relationships with adults who are knowledgeable about how to support their development and learning and are responsive to their individual progress. The book offers guidance on system changes to improve the quality of professional practice, specific actions to improve professional learning systems and workforce development, and research to continue to build the knowledge base in ways that will directly advance and inform future actions. The recommendations of the book provide an opportunity to improve the quality of the care and the education that children receive, and ultimately improve outcomes for children.

An Evolving Approach to the Global Health Agenda: Countries Will Lead the Way on NCD Prevention and Control.

The United Nations (UN) put its stamp of approval on noncommunicable diseases (NCD) as a global health priority at the High-Level Meeting on NCD in September 2011 and then handed the baton to member states to take the next steps in addressing this growing health problem. For a decade, the UN’s World Health Organization (WHO) has advanced the cause of NCD and, for much of that time, was alone with the megaphone. The early attention to NCD from the WHO Director General Gro Harlem Brundtland ultimately led to the Global Strategy on Diet, Physical Activity, and Health [1], the 2008–2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases [2], and other influential documents such as the WHO Expert Report on Chronic Disease [3]. WHO has devoted a greater proportion of the funding within its discretion to NCD than member countries and other donors devote from extrabudgetary resources provided to WHO, and it succeeded in advocating for and then carrying off, in record time, a UN high-level meeting. WHO has not been alone in these efforts. There was energetic and inspiring leadership from the Caribbean countries in both initiating national chronic disease control programs and leading the global advocacy, from the NCD Alliance in organizing and broadening the advocacy movement, and from many other individuals, organizations, companies, and countries who saw the pressing need for attention to NCD. While global and regional activities continue to pick up steam, the center of gravity is now shifting to member states, who

Exploring Country-Level Decision Making for the Control of Chronic Diseases : Reflections from an Institute of Medicine Workshop

As highlighted by the recent United Nations High-Level Meeting on Noncommunicable Diseases in September 2011, chronic diseases are increasingly recognized as a major health problem in lowand middle-income countries, where they are also accompanied by significant economic repercussions [1,2]. Lowand middle-income countries face many competing demands on their available resources, from basic development priorities to a range of important health needs. These countries currently have limited internal resources devoted to chronic diseases and receive little external funding to address this issue [3]. Nonetheless, despite the many challenges, it is increasingly recognized that reducing the burden of chronic diseases in developing countries is not only achievable, but it is also critical to meeting global health and development goals. The Institute of Medicine (IOM) report, Promoting Cardiovascular Health in the Developing World [4], concluded that to accomplish this reduction in chronic disease burden would require:

Potential for Global Progress in Control of Chronic Diseases: A Turning Point in 2011

With the September 2011 United Nations High Level Meeting on Noncommunicable Diseases, the world’s attention is turning to the critically important issue of chronic diseases. The global community is on the threshold of what could be a major change leading to progress in the control of chronic diseases worldwide – progress that could be achieved as a contribution to improving global health overall, rather than as a competition with other diseases that persist as important health challenges in low and middle income countries. This inaugural issue of Global Heart brings together a series of articles and commentaries reflecting some of the key elements that are needed to successfully achieve the promise of progress that the U.N. meeting brings. As a central frame for promoting health and achieving better control of chronic diseases, the issue presents the main messages and recommendations of the 2010 Institute of Medicine report, Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health [1]. In addition to a comprehensive summary of the report, this issue presents in more detail excerpts from the conceptual strategy articulated by the authoring committee and the report’s proposed framework for action. The messages of the report and the framework described are built from the perspective of global cardiovascular disease, a fitting entry point for the inaugural issue of Global Heart. However, in line with the approach to collaboration and partnership embraced by the World Heart Federation and described in this issue by Sidney Smith and Johanna Ralston, the authoring committee of the IOM report recognized

Envisioning a Transdisciplinary University

Achieving social and economic growth requires collaboration, especially in global health. If universities are to improve health globally, they will need to train students and to support faculty who can effectively collaborate with those from other disciplines and cultures.