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.

3 Responses to “ESC Position Paper: Population-Based Strategies to Reduce CV Deaths”

  1. Vincenzo Pazzano, MD says:

    I especially agree with the first of these major recommendations: the consumption of junk food is strongly encouraged by the fact that it is often cheaper than fruit and vegetables or other healthy food like fish. In a period of such a financial crisis this aspect is of primary importance, and should really be ruled out by goverments!

  2. There is considerable hypocrisy, politicizing, and inaction with respect to the environmental and policy alterations needed to bring about changes in cardiovascular risk–obesity, diet and physical activity at the top of the list. Failures abound. The simultaneous battle against childhood obesity, but support of obesogenic food industry practices; the recent back-off of the USDA in “Meatless Mondays”, etc. Special interest groups are being placed ahead of population-based primordial prevention on an ongoing basis. Resistance to dietary improvement based upon personal freedom of choice, even opposition to new parks locally, all add up to a dismal future for prevention. Yet at the same time, the IOM, and even an editorial in today’s NEJM, emphasize the societal contribution to obesity. The people who have the power to enact these policies are not serious enough. There is a wide chasm between recommendations and what “should be”, and the reality. It all adds up to more inaction, higher BMIs, more debate about statins with McDonalds.
    Richard Kones MD

  3. The policies in the UK to reduce smoking in public places have transformed the experience of going out. Visiting France this year brought home the differences. I agree that the policies that have been applied to smoking should be used to nudge people in other aspects of their life.