July 26th, 2012
ESC Position Paper: Population-Based Strategies to Reduce CV Deaths
About half of all cardiovascular deaths could be prevented by implementing population-level changes, according to a position paper from the European Society of Cardiology published in the European Journal of Preventive Cardiology. Torben Jørgensen and colleagues maintain that population-level interventions are much more effective than current strategies that seek to reduce individual risk.
Population-based strategies include taxation, legislation, and environmental changes. The authors call the move away from individual risk and toward a population-based strategy “a paradigm shift in CVD prevention.”
The authors argue that the change is necessary because “societal changes during the last decades have led to the present harmful environment with high calorie intake, low degree of physical activity, continuous smoking, and high alcohol intake.” Further, they note, efforts to promote a healthy lifestyle “routinely face opposition by commercial vested interest from corporations (e.g., food, tobacco, alcohol).”
Addressing a common criticism of population-based strategies, the authors counter the allegation that the “‘nanny state’ hinders the free choice of people” with the observation that “people today are nudged in the wrong direction by corporations’ de facto setting of the default option. Yet corporations do not have responsibility for population health – this is the responsibility of governments.”
“Population interventions make the environment healthier and change happens automatically, whereas with an individual approach you need an active response,” said Professor Simon Capewell, a coauthor of the paper, in an ESC press release.
Here are several of the paper’s major recommendations:
• Healthy dietary habits will be supported by changes in agricultural policies, tax on products with free sugar and saturated fat and subsidies for fruit and vegetables, reduction of salt and trans-fatty acids in processed foods, clear labelling of foods, and limiting advertising for junk food.
• Completely smoke-free environments are the only way to protect non-smokers. Smoking and second-hand smoking can be regulated by taxation, restrictions in sale and use, banning advertising, plain packaging, and warning labels.
• Physical activities should be integrated in daily life by subsidies to public transport and re-allocating of road space to cycle and footpath lanes. Changes in schools, worksites, and built environment can make physical activity a more natural part of daily life.
• Alcohol intake can be reduced by taxation, low availability, regulation of advertising, and low social and legal tolerance of drink driving.