Updates from the field – CVD focus

This week the Blog entries from Tanzania and Poland are courtesy of the groups working on the theme ‘cardiovascular disease’. It’s fair to say that both groups have had different yet insightful visits to far. We hope you enjoy reading about there experiences.

Could psychosocial prevention strategies be key to reducing CVD? 

By Lucas Pahlisch

As a global health studenttravelling to Central and Eastern Europe to study Cardiovascular Disease, it has been the most interesting struggle trying to make sense of all the data available for this part of Europe. By only looking at CVD death rate, one can be startled by the disparities existing between Central and Eastern European countries. Some of them have had their CVD death rate declining constantly since 1990 like Poland or Latvia. Others, like Ukraine or Russia were less fortunate and in 2011 had a CVD death rate more than twice as big as the lowest one in Central and Eastern Europe according to the European health for all database. One can they ask, why is Poland doing so much better?

Poland 1

After 1989 and the dissolution of the Soviet Union, Poland became a sovereign country. It quickly started a vast economic reform to turn the country toward a capitalistic model. It is worth noting that during soviet time, there was no health promotion whatsoever. Poland was one of the former soviet countries that turned its economy the most successfully, and it is tempting to attribute its health success to this factor alone. For the comparison, Ukraine has a GDP of 3’867 USD per inhabitant and Poland has almost more than three times that amount with 12’708 USD per capita. However, there are a lot of other factors that influence CVD and CVD death rates, in Poland these rates started declining well before its economical success. Moreover, the improvement in medical equipment and notably angiography equipment cannot account for the decline in CVD as it also occurred well after the sharpest decline was noticed. Beside, even with this somewhat high GDP (compare to Ukraine), when visiting a cardiology unit in Krakow, lack of funding was still cited has an issue preventing clinicians from meeting every patients needs.

Poland 2

Of course, Poland also implemented a number of prevention strategies in order to promote healthy behaviour regarding CVD risk factor, such as the anti-smoking program. However, the classical « lifestyle » risk factor cannot alone account for every CVD occurrence. More and more, psychosocial risk factor, such as stress, are under the scope of the scientific community. There is of course the famous type-A individual, a psychological profile matching someone who is never satisfied with his work and constantly challenging himself to perform better. Such mental states, which lead to a stressful life, have been linked with an increase risk of CVD. It is following such evidence that Andrej Pajak and Magdalena Kozela suggested that the perception people have on their country’s economical state can influence the population CVD death rate. It is such perception that could explain the difference observed between a number of countries in Central and Eastern European. Following this hypothesis, countries who perceived the economic changes following the collapse of the Soviet Union as benefit for their country would have a lower CVD incidence. And thus, having an open mind toward change may lead to better health.

Time for Tanzania to scale up the primary prevention

By: Lone B Rasmussen, Hillary Smith-Dam, Andrea Stanglmair, Pernille Klarskov Stage & Jack Fisher

Tanzania. A land covered in sunshine, rich in its wildlife and friendly people who greet you with ‘Jambo?. In many ways the region of Kilimanjaro shows some of the best health care services in all of Tanzania and funding have ensured great improvements in maternal health care, TB and HIV treatment to name a few. However, the country also shows another less addressed side, namely the growing problem of non-communicable diseases the population now face. Hypertension and diabetes are significantly undiagnosed and under treated within Tanzania and Sub Sahara Africa. Even in Kilimanjaro region where health facilities are generally good, proper diagnostic tools and awareness campaigns enlightening the issue of NCDs are at a minimum.

ln the cases where treatment is sought the clinical manifestations present themselves at a late stage when it is often difficult to prevent mortality. Tanzania is therefore now experiencing a double burden of disease of CDs and NCDs. Recent studies have shown that even some communicable diseases, such as malaria, can have an impact on the risk of developing CVDs later on in life. These finding increases the need for not only focusing on communicable and no-communicable diseases separately but to acknowledge the link between the two, and make sure that both receive equal attention.

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In many high-income countries the increase of cardiovascular disease have been associated with a diet high in saturated fat, sugar, salt, smoking, alcohol intake and physical inactivity. Lifestyle factors, or life conditions as some would argue, play a key role in the dramatic increase in hypertension within Tanzania. Ultimately globalisation and urbanisation has greatly attributed to companies such as Coca Cola to exploit and reap a vulnerable unregulated Tanzanian market. If you had no prior knowledge on Tanzania, you would easily think the national colours were red and white. Ranging from boutiques to bakeries, hospitals to hotels, emergency services to educational establishments, they all have the famous soft drink branding. It’s a simple but cunning marketing ploy to have everyday essentials such as tables, chairs, signs, parasols sponsored by Coca Cola. There is also little difference between urban, periurban and rural settings where the vast majority of outlets have Coca Cola easily available on the eye and in the fridge.

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There is no doubt that if NCD policies are to attempt primary prevention strategies within Tanzania, then rules and regulations are needed not only on soft drinks advertisement, but also relating to smoking and alcohol. The Tanzanian population should be provided with the knowledge on the consequences of consuming soft drinks, cigarettes and alcohol intake. Furthermore by increasing awareness campaigns at a school based level highlighting the importance of of getting blood pressure regularly measured is essential in educating the younger Tanzanian generation.  Two-thirds of the 33% of the SSA population, of whom are aged between 10-24 years of age, growing up in slum like conditions in a context of widespread poverty, rapid urbanisation, limited education opportunities and rapidly evolving transformations of traditional norms. As a result an accumulation of the environmental factors, lack of awareness, health services and national policies on the relationship with HTN and CVD, leaves TZ’s young adults as a high risk group for developing CVD complications throughout the life course. Therefore, by targeting adolescents behavioural risk factors by increasing awareness through primary education could be a starting point in tackling hypertension. Other similar school based interventions have been successful in raising awareness in other health challenges such as HIV and AIDs. Therefore this approach wouldn’t necessarily reinvent the wheel, but build on and adapt successful existing preventative strategies to delay and manage this essential health challenge.

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Thanks for reading. Tune in again next week for more !!

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