BUILDING CAPACITY FOR HEART HEALTH IN AFRICA

1. BUILDING CAPACITY FOR HEART HEALTH IN AFRICA Dr. Kingsley K. Akinroye Vice – President African Heart Network At African Heart Network Workshop Maputo, Mozambique Nov. 20th 2008

5. RISK FACTORS FOR HEART DISEASE • High blood pressure • High cholesterol • Tobacco use • Low intake of fruit and vegetables • Overweight • Physical inactivity

6. 2005 WHO REPORT • 17 million people (of the world’s population) die of CVD • Several millions suffer life-long disability (80% in developing countries)

7. WHY INVESTING IN HEART HEALTH? • Decrease in heart disease • Decrease in strokes • Lesser disability

8. WHAT POLICIES COUNTRIES NEED TO ADOPT • Reducing salt in foods • Cutting dietary fat • Promoting Exercise • Encouraging higher consumption of fruits and vegetables • Lowering smoking • Use of affordable, available, locally manufactured drugs.

9. VARIATIONS IN COUNTRIES & COMMUNITIES • Economic conditions • Health Status • Education • Culture • Politics

10. SUCCESS ‘STORIES’ OF COMMUNITY PROJECTS • International perspectives • Africa Region

11. PAWTUCKET HEART HEALTH PROGRAM (PHHP)(RHODE ISLAND, USA) • Initiated 1980 • Change behaviour patterns to prevent and control CVD • Started in a community hospital Board of Directors decision to reduce the city’s high rate of CVD

12. PAWTUCKET HEART HEALTH PROGRAM (PHHP) • Hired a Hospital Director (HD) Background in preventive care HD designed preventive programmes targeted at the population • PHHP used existing community resources to plan for implementation viz: Social organizations Local government

13. PAWTUCKET HEART HEALTH PROGRAM (PHHP) Libraries Schools (Public + Private) Faith-based organizations Mass Media Supermarkets Local business Restaurants Grocery stores Medical establishments

14. PAWTUCKET HEART HEALTH PROGRAM (PHHP) • The strength of the Pawtucket community intervention was its VOLUNTEERS. 3,600 people in the community of surrounding areas volunteered their services. 40 percent of citizens of 500 organizations in the study community participated in behaviour change programmes

15. PAWTUCKET HEART HEALTH PROGRAM (PHHP) Lesson: - Any community group can be involved in primary prevention - Community efforts can be used as a model for replication

16. STANFORD COMMUNITY HEART HEALTH PROJECTS • After World War II there was a rise in CVD in the American population • By late1960s scientists and public health officials recognized the need for primary prevention strategies to reduce the increase in CVD • With Federal government aid, the Stanford projects started with Cardiologist, a social psychologist and a lipid chemist. (This was the first group in USA to attempt a comprehensive, community wide educational approach in non communicable diseases prevention)

17. STANFORD COMMUNITY HEART HEALTH PROJECTS • 1972 – 1975: The three-community study was conducted 1st Community was a control 2nd Community received media education only 3rd Community received media education Result: 24% decline amongst adults in estimated risk of future heart attack and strokes Media – only treatment was effective in achieving significant improvements

18. STANFORD COMMUNITY HEART HEALTH PROJECTS From 1978 – 1996: The Five-City project was conducted by adapting the methods of the Three – community study in larger communities. Result: All risk factors for CVD (except body weight) improved Benefit: At the conclusion of the Stanford intervention in 1986, there was the successful maintenance of a CVD prevention programme

19. NORTH KARELIA, FINLAND: COMMUNITY INTERVENTION • Project was initiated in 1972 • Combined educational, environmental and policy interventions to prevent CVD. • Information that North Karelia had the highest rate of CVD mortality in the world. • Citizens petition for action to Government followed by Government support. • Local and National authorities, and experts backed the project. • Link with WHO

20. NORTH KARELIA, FINLAND: COMMUNITY INTERVENTION • Activities Risk factor screening programmes Professional education Initiatives to effect changes at community e.g. Low-fat cooking classes Collaboration with the house- wives association helped to influence dietary habits Competition between villages – reduction in cholesterol levels.

21. NORTH KARELIA, FINLAND: COMMUNITY INTERVENTION Result: - All major risk factors decreased in North Karelia throughout the period of the study. - CVD mortality rates fell by 57% between 1970 and 1992 - Fat intake was reduced - Fruit and vegetable intake increased - Smoking among men decreased

22. PORTUGAL’S EXAMPLE TO IMPLEMENTING COMMUNITY CARDIOVASCULAR DISEASE PREVENTION “Heart disease before eighty. It is man’s fault, not God or Nature’s will” (Paul Dudley White 1952) • Above inspiration touched Fernando de Padua, a graduate student at Harvard, and the Massachusetts General Hospital • Back to Portugal • Initiated using Newspapers to disseminate CVD prevention messages with emphasis on high salt intake of Portuguese diet.

23. PORTUGAL’S EXAMPLE TO IMPLEMENTING COMMUNITY CARDIOVASCULAR DISEASE PREVENTION • Health promotion articles were not acceptable in Europe till 1972, hence he could not publish in journals. • By 1972, he became a Professor, and started to involve the community in a national fight against hypertension. • Later – Radio, Movie theatres and national TV. • F. de Padua TV program gained popularity • Volunteers started checking blood pressure in Subway & train stations + distribution of printed materials in conferences & festivals.

24. PORTUGAL’S EXAMPLE TO IMPLEMENTING COMMUNITY CARDIOVASCULAR DISEASE PREVENTION • Portuguese health authorities were alerted to the CVD challenge • Base line data were collected, to indicate that 30% of the Portuguese were hypertensive • Visit of three (3) eminent Cardiovascular epidemiologists to Portugal • Production of a CVD prevention booklet with Padua plus one-hour long TV interview on the only national TV (was a turning point)

25. PORTUGAL’S EXAMPLE TO IMPLEMENTING COMMUNITY CARDIOVASCULAR DISEASE PREVENTION Result: Portugal stroke mortality decreased by 30%; ischemic heart disease decreased by 25% Foundations of: - Centre for the study of Preventive Cardiology - Portuguese Heart Foundation - National Institute of Preventive Cardiology

26. WORKSITE INTERVENTION:ELECTROSTAL, RUSSIA - CINDI Project - To reduce hypertension - Town of Electrostal(Russia) - Project started 1987

27. WORKSITE INTERVENTION:ELECTROSTAL, RUSSIA Hypertension control programme – for 13,000 employees at a pipe line plant Health care units, staffed by Nurses in all departments Program: Detection Lifestyle counseling Non pharmacological reduction of risk factors Drug treatment

28. WORKSITE INTERVENTION:ELECTROSTAL, RUSSIA Results: After 5 – year follow-up - 73% of hypertensive were under control - 54% maintained blood pressure <160/90 mm Hg - Absenteeism due to hypertension and other conditions decreased by 30%

29. JAPANESE SUCCESS IN REDUCING STROKE MORTALITY “If I were to put an ultimate valuation on my health, l should probably adopt a Japanese diet, as the Japanese are the longest-lived people in the world” (G. Rose 1992) • 1970 - Stroke was the major killer in Japan • Last three decades, Japan has recorded the largest reduction in stroke mortality in the world.

30. JAPANESE SUCCESS IN REDUCING STROKE MORTALITY • Risk factors for stroke in Japan were identified • Diet was recognized as a top priority Reducing dietary sodium Increasing potassium, calcium and other nutriets • Japan School lunch system • Housewives were provided health education from public health service organizations, local government and the private sector • Mass media was used to influence home meal cooking • Free annual health checkups at worksites and all communities

31. JAPANESE SUCCESS IN REDUCING STROKE MORTALITY • The Socialized health care system covered individual medical expenses and therefore encouraged more people to see a doctor – increased early detection and treatment • Lifestyle pattern modification especially nutritional habits were the most important determinant of the observed reduction in stroke mortality.

32. AFRICAN REGION EXAMPLES • Tunisian National Programme to control CVD • South African Sow-a-Seed Child Programme • Kenyan Talking Wall Programme • Nigerian Tobacco Control Programme • Rheumatic Heart Disease Programme - ASAP

33. WORLD HEART FEDERATION/ AFRICAN HEART NETWORK UNIVERSITY (American Cancer Society University Experience)

34. AFRICAN HEART NETWORK INITIATIVES • Opportunities ? • Challenges ?

35. THANK YOU