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Tackling health inequalities through CVD prevention

Tackling preventable cardiovascular disease and ill-health is one of the most important things we can do to tackle health inequalities and protect our health and social care system, argues Professor Jamie Waterall, national lead for cardiovascular disease prevention at Public Health England.

As one of the leading causes of disability and death in England, cardiovascular disease (CVD) is one of the biggest threats currently facing our health and social care system. Almost seven million people are living with CVD nationally and it costs the NHS an enormous £7.4bn each year. Deaths from heart attack and stroke are falling, but these events still claim 84,000 lives annually, with a preventable death happening every half an hour.

Social injustice

CVD is one of the conditions most strongly associated with health inequalities. Smoking, alcohol and lack of physical activity are some of the major risk factors and, worryingly, these are more prevalent in lower socioeconomic groups. If you live in our most deprived communities, evidence shows that you’re almost twice as likely to die prematurely as those in the least deprived. You’re also 30% more likely to have high blood pressure, the biggest single known risk factor of heart attack and stroke.

We need to tackle this injustice as everyone has the right to live longer and in good health, regardless of their background or circumstances.

Through our public health campaigns, we are already helping more people quit smoking, cut down on alcohol, aim for a healthy weight and lead more active lifestyles. And with prevention and CVD being major new priority areas in the NHS long term plan, there is a real opportunity to accelerate our efforts. We know what works in preventing CVD, but putting this into practice is more challenging, particularly when ensuring that those at greatest risk are supported.

Cultural change

High blood pressure, high cholesterol and atrial fibrillation are some of the most common risk factors of heart attack and stroke. Yet millions of people live undiagnosed because the symptoms are often invisible. We need a cultural shift to start normalising conversations around blood pressure and cholesterol, encouraging people to know their numbers so they can identify risk early on. This is an area where we lag significantly behind other nations such as Canada.

Targeted information to help people find out their risk and make important lifestyle changes to reduce this is essential. There are a growing number of local interventions which have successfully reduced heart attacks and strokes and which are being adopted by other regions, notably the Bradford Healthy Hearts initiative.

One way we can encourage more conversations is by making it easier for people to learn about their heart health. The Heart Age Test is an example of a tool that is giving people flexibility to do this from wherever they are, without needing to visit a clinical setting. Since we re-launched the tool earlier this month we have seen a huge increase in the number of people accessing advice on how to make healthy and important lifestyle changes.

NHS Health Checks

Increasing uptake of the NHS Health Check is another vital way to help more people spot early signs of heart disease and stroke. For every six to 10 NHS Health Checks, one person is identified as being at high risk of CVD, with research showing that people who attend a check are more likely to be referred to lifestyle management services than those who do not.

Significantly, take up of the NHS Health Check is high among deprived areas. In many cases this is thanks to innovative work at local level to promote the check to those who need it most, working in partnership with other community services to do so, including pharmacies and the fire service.

Every local authority has a duty to offer these checks and we are working hard to support them, developing new tools to help them identify the cost and health benefits that come through investing in prevention.

Greater ambition

With as many as four in five premature heart attacks and strokes being preventable, we have a huge opportunity to stop more people from dying or suffering unnecessarily.

In addition to the important steps outlined here, we also need to be more ambitious in what we can achieve. Through a newly established PHE-led working group involving over 30 organisations, we will soon be publishing national ambitions around CVD prevention for the first time.

By working together, the public, professionals and society as a whole, we can make a difference to so many people’s lives now and in the future.


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