Prevention of cardiovascular disease at population level

1. Prevention of cardiovascular disease at population level Implementing recommendations for practice June 2010 NICE public health guidance 25

2. What this presentation covers • Background • Recommendations for practice • Costs and savings • Discussion • Find out more

3. Background • CVD led to nearly 160,000 deathsin England in 2007 • Most premature deaths from CVD are preventable • 5.6 million adults in the UK are living with CVD • In over 90% of cases, the risk of a first heart attack is related to nine modifiable risk factors

4. Recommendations for policy A national framework for action on: • salt • saturated fats • trans fats • marketing and promotions towards young people • commercial interests • product labelling • Health Impact Assessment • Common Agricultural Policy • active travel Full details of these recommendations are included in the slide set ‘Prevention of cardiovascular disease at population level – implementing policy goals’ available from www.nice.org.uk/guidance/PH25

5. National policy • Accelerate reducing salt intake among the population to a maximum of 6g per day for adults by 2015 and 3g by 2025 • Eliminate the use of industrially-produced trans fatty acids (IPTFAs) for human consumption • Encourage a substantial reduction in the amount of saturated fat in all food products • Establish guidelines for local authorities to monitor IPTFA levels in local food provision using existing statutory powers

6. Policy areas for local leads • Ensure guidance for local transport plans supports physically active travel • Ensure publicly funded catering departments meet Food Standards Agency-approved dietary guidelines • Encourage local planning authorities to restrict planning permission for take-aways and other food retail outlets in specific areas • Use population surveys  and data from all relevant sources to monitor intake of nutrients for all population groups

7. Recommendations for practice • Regional CVD prevention programmes • Children and young people • Public sector food provision • Physical activity • Health Impact Assessments • Take-aways and other food outlets • Nutrition training

8. CVD programmes:good practice Local and regional CVD prevention programmes should: • comprise intense, multi-component interventions • target the whole population • complement initiatives for individuals at high risk • be sustainable for a minimum of 5 years • be allocated adequate time and resources.

9. CVD programmes: preparation • Find out about CVD prevalence and incidence locally • Identify groups that are disproportionately affected • Consider how policies related to food, tobacco control and physical activity may affect local prevalence • Gauge the community’s knowledge of CVD risk factors and their ability to make changes to reduce the risk

10. CVD programmes: development • Ensure the programme:- adopts a population-based approach- is underpinned by sound theory- helps address local targets- acts as an incentive for commissioning- tackles health inequalities - links to strategies targeting people at high risk of CVD.

11. CVD programmes: resources • Ensure the programme lasts a minimum of 5 years and is adequately staffed • Produce a long-term plan – and gain political commitment – for funding beyond the end of the research or evaluation period • Volunteers should be an additional – rather than a core – resource

12. CVD programmes: leadership • Identify senior figures within PCTs and local authorities to act as champions • Identify – and provide for training for – people to lead the CVD programme, including local people • Develop systems within local strategic partnerships and regional (or sub-regional) partnerships to agree shared priorities

13. CVD programmes: evaluation • Budget for and establish baseline measures before the CVD programme begins • Ensure evaluation is built in from the outset • Ensure appropriate methods are used to: - evaluate programme processes- capture health outcome measures or indicators

14. Health Impact Assessment • Assess the potential impact that all local and regional policies and plans may have on rates of CVD and related chronic diseases • Monitor outcomes following an assessment and usethis to follow-up and amend plans • Identify local expertise to carry out these assessments

15. Children and young people • When food and drink is procured with public money ensure a range of affordable, healthier options is provided • Ideally, healthier options should be cheaper than the less healthy ones • Public sector organisations should avoid sponsorship from companies linked with foods high in fat, sugaror salt

16. Public sector food provision • Ensure all food provided for and by the public sector:- is low in salt and saturated fats- is nutritionally balanced and varied, in line with recommendations made in the ‘eatwell plate’- does not contain IPTFAs.

17. Nutrition training Training for catering managers should: • integrally link nutrition and health • highlight the adverse health effects from;- conventional frying practices- the use of salt- industrial trans fats- saturated fats • promote awareness of healthy alternativesbased on the ‘eatwell plate’.

18. Physical activity Local authorities and PCTs should ensure: • the physical environment encourages people to be physically active • the need for children and young people to be physically active is addressed Apportion part of the local transport plan (LTP) allocation to promote walking, cycling and other formsof travel that involve physical activity.

19. Take-aways and other food outlets • Regulate opening hours - particularly of outlets with foods high in fat, salt or sugar – that are near schools • Use existing powers to set limits for the number of outlets in a given area • Establish guidelines for local authorities to monitor trans fatty acid levels in food sold using existing statutory powers

20. Costs and savings per 200,000 population * Costs and savings related to CVD events in this table apply to a population aged 40 years and over.

21. Discussion • What can we do to ensure our regional CVD programmes are sustainable? • Are population-based CVD approaches prioritised within local delivery and commissioning plans? • How can we encourage non-NHS policy and planning colleagues to get involved? • Who could champion our regional CVD prevention programme?

22. Find out more • Visit www.nice.org.uk/guidance/PH25 for the: • guidance • quick reference guide • costing report and template • audit self-assessment tool • checklist for overview and scrutiny committees