Cardiovascular diseases:

A European Commission

Perspective

Michael Hübel

European Commission, DG Health

and Consumers

Ischaemic heart diseases and cerebrovascular diseases as percentages of total death rates 2006

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15,0%

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30,0%

35,0%

40,0%

45,0%

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Ischaemic heart diseases (I20-I25) Cerebrovascular diseases (I60-I69)

CVD – largest single cause of death in EU

Source: atlas of mortality in the European Union. Eurostat 2009

More than 2 fold difference in death rates between EU Regions

Higher risk of CVD for poor and less well educated

SDR, diseases of c irculatory system , all ages per 100000

0

100

200

300

400

500

600

700

1970 1980 1990 2000

EU EU members before May 2004 EU members s ince 2004 or 2007

20-50% decline in CVD mortality since 1980

Source WHO HFA Database 2009 – standardised death rates all ages

Common determinants of CVD and other non communicable diseases

Social and economic situation

Unhealthy Physical Tobacco Alcohol diet inactivity use

CVD Cancer Type 2 COPD Mental Musculoskeletal Oral

diabetes health disorders health Figure: Causal factors of major non-communicable disease Environmental quality

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% of deaths caused by key risk factors

Source: Global health risks: mortality and disease attributable to selected health risks. WHO 2009, table 1 – high income countries

                          

  

                  

                   

                       

               

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Overall approach – the EU Health Strategy, EU2020

Determinants – socio­economic, environmental, behavioural

Partnership with MS and Stakeholders Values – equity, health is wealth,

Health in All Policies

EU initiatives – health inequalities, environment and

health, tobacco, nutrition, physical activity, alcohol,

mental health

Specific CVD activities, MS, Stakeholders, Indicators,

Research

Emerging chronic disease alliance

      

              

                      

                   

                        

     

Socio­economic determinants – “Solidarity in Health” COM(2009)567

Strengthen collaboration with Member States,

Regions and other Stakeholders

“A fair distribution of health as part of overall

social and economic development”

Improve measurement and knowledge

Health inequality policy audit Action for vulnerable groups – Roma, migrants

Use of structural, cohesion, rural development

Use PROGRESS, Health Programme and other

funds

Initiative on global health

   Broader health determinants

        

        

                              

                

Tobacco

Legislation

Advertising, Warning messages and pictures

Products

Smoke free environments

Link to international work (FCTC) Prevention work: Youth campaigns

2002­2004: ‘Feel free to say no’

2005­2008: ‘HELP’ ­ 72 Mio €/4 years

2009­2010: HELP 2.0 – 32 Mio €/2 years

Network tobacco control initiatives

Exchange Best Practice and develop European

projects

          

                      

                    

                              

                                       

Developing New partnerships: Nutrition and Physical Activity Alarming rates of obesity in particular in young people –

diet/activity key health determinants

EU role in food law (labelling, health claims) ­

agriculture, education, transport, taxation…

Consumer information, advertising and marketing

Develop new partnerships

2004: Roundtable on Obesity

2005: Platform on Diet, Physical Activity and Health

A new strategy

2005: Green Paper (consultation)

2006: White Paper on Nutrition and Physical Activity

2007: High Level Group – 2008:Salt initiative 2009: Fat and

sugar reformulation

            

       

     

     

 

             

            

     

Alcohol

2006: Communication on alcohol­related harm

Young people and children

Road traffic and drink driving

Adults and the workplace

Information and awareness raising Evidence base

Work across policies and with Member States

2007: Alcohol and Health Forum

100+ commitments for action

Annual Open Forum meetings

 

            

     

              

     

 

   

         

Mental health

October 2005: Green paper consultation – open

and structured

December 2007: New departure 2008 European Pact and high level conference

Suicide and depression

Young people and education Workplace

The elderly

Stigma and discrimination

2009­11 Thematic conferences on priority

themes

   

   

 

     

   

CVD specific activities

Member States, Council

Stakeholders –

European Heart Health Charter

Health Programme Funding

Indicators

Research

          

              

                     

                

               

                  

     

Council Conclusions on heart health –

June 2004

encourage networking and the exchange of

information between stakeholders strengthen the comparability of data

European food and nutrition policy, to include,

physical activity

take a multisectoral approach to preventing

cardiovascular disease and assessing the health

impact of other public policies of the European

Union;

co­operate with the relevant international and

inter­governmental organisations, in particular

the World Health Organisation

 

    

 

Commitments on Heart Health Luxembourg declaration (2005):

Necessity for comprehensive

strategies

Heart Health Charter Cooperation cardiologists – heart

networks key success factor

EU Heart Health Charter Principles

Policies

EU Heart Health Charter

Stakeholders

NationalNationalHe rtNaationalHearNattionalHealthHeartHealthHeartStrategiesHealthStrategiesHealthStrategies

Strategies

Monitoring

          

               

     

     

        

Facilitate and support national strategies – Bottom­up approach

Heart Health Charter development process – consensus building process

among stakeholders

Mobilisation in Member States key

Primary carers/health professionals as

actors in prevention and health

promotion

Build partnerships: determinants,

diseases, screening, treatment?

     

 

Health systems

Emerging cooperation between

Member States

The example of cancer screening

Patient Mobility Directive

Structured cooperation between

Member States

   

           

                  

  

         

 

       

Indicators and statistics Responding to the need of comparable indicators for cardiovascular diseases monitoring EUROCISS 1 ­ Cardiovascular Indicators surveillance set

in Europe (Phases 1, 2)

Cardiology Audit and Registration Data Standards

(CARDS) project

Responding to the need of comparable incidence data for coronary events European Cardiovascular Disease Statistics ­ European

Heart Network

Responding to the need of cardiovascular mortality comparable data Eurostat Atlas of Mortality: cardiovascular diseases

  

                    

                      

                      

                      

                                   

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EUROCISS 2 ­ Cardiovascular Indicators surveillance set

in Europe (Phase 2) Project ­ 2008

to define indicators for monitoring CVD to recommend standardized methods for collecting

indicators in EU countries

to prepare manuals of operations describing in detail

procedures and methods for easy implementation of

population­based registers and CVD surveys.

The achievement of EUROCISS 2 aims

will facilitate cross­country comparisons and

Will assist efforts to improve the prevention and control of

CVD.

   

Research projects FP6/FP7 Integrated Project focusing on the genomics of atherothrombosis Network of Excellence in vascular biology Integrated Project on signalling molecules involved in disease mechanisms Towards the stabilisation of atheromatous plaque Genetics of Thrombotic Stroke Cell Transplantation for Myocardial Repair Adult Stem Cell Research

       

                                 

                        

                    

                        

                                   

                      

Projects from the Health Programmes

Children, obesity and associated avoidable chronic diseases

(European Heart Network)

European Mapping of Obesity Best practice (Learning Lab

Denmark)

Development & Implementation of a European Guideline and

training standards for Diabetes Prevention (Technische

Universität Dresden, Medizinische Fakultät Carl Gustav)

Promotion of vegetable and fruit consumption of school children

(Karolinska Institute)

Building Policy Capacities for Health Promotion through Physical

Activity among Sedentary Older People (Univ. Erlangen)

Move Europe ­ a Campaign for the Improvement of Lifestyle­related Workplace Health Promotion in Europe (European

Network for Workplace Health Promotion)

Shape Up – towards a European network for obesity prevention

in children (PaU Education, Barcelona)

   

            

                     

     

           

                      

           

         

A chronic­diseases alliance Ad­hoc alliance of medical & health promotion organisations

Aiming at producing a policy document:

Underlining the NCD challenge addressing common health determinants (tobacco,

nutrition, physical activity, alcohol); Developing a set of joint life­style

recommendations;

targeting EU policy makers;

to be shared with the Belgian Presidency for their

planned conference on chronic diseases (October

2010);

to be ready by spring 2010