epidemic in low and middle income countries have continued to grow with increasing intensity over the past several decades. Professional organizations (national and international) as well as CVD and chronic disease advocacy organizations initially spearheaded this push, organizing a steady stream of declarations, campaigns, and conferences to raise awareness (see Chapter 1 for a more detailed description of these efforts). These succeeded in catching the attention of the international community, which, over the course of the 1990s and early 2000s, has begun to embrace the cause.

Since the mid-1990s, the World Health Organization (WHO) has joined in these advocacy efforts, sponsoring a series of white papers, declarations, and events aimed at convincing donor agencies and national ministries of health of the importance of addressing CVD as well as preparing a toolkit for chronic disease advocacy efforts (WHO Department of Chronic Diseases and Health Promotion, 2006). These efforts have yet to result in significant investment; however, they do appear to have had some success in starting to convince some in the international development assistance and global health donor community that chronic diseases should be a part of the global health agenda. Part of the reason for this lack of success in stimulating investment in chronic disease prevention is that, although there are many advocacy groups working on chronic disease issues, there is little coordination and communication among them, and thus efforts can be fragmented and lack unified messages. More recently this has begun to change, most notably through a partnership for chronic disease advocacy among the World Heart Federation, International Diabetes Federation, and International Union Against Cancer (International Diabetes Federation et al., 2009).

The challenge for advocacy efforts, moving forward, will be to convince ministries of health in low and middle income countries, development assistance agencies, and other donors that investment in CVD prevention and control is critical despite their highly constrained health budgets and many competing health and development priorities. A key challenge in this effort will be to target advocacy efforts at infectious disease, maternal and child health, health systems strengthening, and other global health programs to better communicate the reasons and opportunities to promote the integration of basic chronic disease prevention and management into their existing programs.

In addition to the direct advocacy efforts of CVD and related chronic disease stakeholders, strategies using mass media, media advocacy, social marketing, and social mobilization can serve as conduits of information and mechanisms for advocacy to build support among the various other stakeholders in the global health arena: governments, multinational agencies, scientists and academic institutions, civil society organizations, public health and health care practitioners, and the general public.

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