shift in the global health and development agenda to facilitate critical next steps that will build toward the eventual goal of widespread dissemination and implementation of evidence-based programs, policies, and other tools to address CVD and related chronic diseases in developing countries.


The actions needed for an individual to prevent and treat CVD are deceptively straightforward: eat a healthy diet, remain physically active throughout life, don’t use tobacco, and seek health care regularly. The reality is much more complex. Behavior change is difficult, individual choices are influenced by broader social and environmental factors, and many people do not have the resources or access to seek appropriate health care.

Solutions can also seem simple at the level of governments and other organizations. Declarations have called on governments to invest more in CVD, to develop laws to protect health, and to ensure access to services to meet the cardiovascular health needs of people. International conference recommendations have demanded that food companies restrict marketing of certain products to children; eliminate transfats and reduce saturated fat, unhealthy oils, sugar, and salt in their products; and make healthy foods more affordable and available. In reality, however, governments and donors need to balance many competing priorities in the allocation of resources, and the level of capacity and infrastructure to support action varies among countries. Context is also critical; programs and policies that have worked in one environment may not work in another. The health systems infrastructure in many countries is insufficient to support chronic disease prevention, treatment, and management. Companies are obligated and motivated to meet the needs of their shareholders even when willing to collaborate to work toward public health goals. These realities have often not been fully considered in the effort to draw attention to the compelling burden of CVD and to call for action.

Along with the need to recognize these realities in the effort to implement policies and programs, the committee identified several key barriers to progress in controlling the global epidemic of CVD. There is concern that attention to CVD would detract from other health needs; there is uncertainty about the effectiveness and feasibility of policies, programs, and services in the contexts in which they need to be implemented; efforts among stakeholders are fragmented and there is a need for focused leadership and collaboration centered on clearly defined goals and outcomes; there is a lack of financial, individual, and institutional resources; and there is insufficient capacity to meet CVD needs in low and middle income countries, including health workforce and infrastructure capacity as well as implementation and enforcement capacity for policies and regulatory approaches.

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