Public Release: 

Can we change society?

By Professor Jaakko Tuomilehto

European Society of Cardiology

Barcelona, Spain, 31 August: Cardiovascular diseases (CVD) result from a negative interaction between genes, lifestyle and environment. To prevent CVD, it is necessary to influence the natural history of the disease development in an individual. While we cannot change our genes, we can do a lot to our lifestyles and environments. It is generally agreed that individuals alone should not be blamed for chronic diseases such as CVD, but that society also has its role and responsibilities. Governments, in cooperation with their stakeholders (e.g., industry, nongovernmental organizations, and health professionals), play a central role in creating an environment that empowers and encourages individuals, families, and communities to make positive, life-enhancing behaviour changes in terms of diet and patterns of physical activity. In addition to direct health policy and services, the responsibility of governments includes sectors that have a pivotal influence on health, such as agriculture, education, and transportation. Social determinants of health are also mediated by fiscal policy and employment opportunities. Consequently, it is imperative that the executive of the government, especially the head of the government, and the finance minister be involved in discussions that traditionally have been limited to matters of microeconomic reform inside the health portfolio. Commerce, industry, and labour traditionally have not been invited to the discussion, but should also be involved.

The WHO states that civil society and nongovernmental organizations can help to ensure that consumers ask governments to provide support for healthy lifestyles and ask the food industry to provide healthy products. Civil society is the key platform for mobilizing and actualizing associative behaviours designed to promote awareness, education, and advocacy for health. They advocate for representatives of business and commerce becoming involved in defining the problem, proposing solutions, and implementing those solutions, because a healthy workforce and market are central to these representatives' core business. Recently, it has also been noted that the power of the Internet in promoting what may be called the "globalization of associative behaviour" is important.

"Parents Jury" is a case in point. It is an Internet-based initiative that offers parents information and a say in matters that affect their children's physical activity and nutrition (e.g., advertising of junk food during prime time television hours). "GLOBALink", another Web site, passes on lessons from one generation of tobacco control advocates to the next, and "Patient View", a group that monitors and analyzes developments in health, communicates its findings with health and social campaigners via its electronic publication, HSCNews. The "People's Health Movement" is another "free association" that is working to influence social policy. Guided by a vision of "a world in which people's voices guide the decisions that shape our lives, The Peoples' Health movement leads the production of "Global Health Watch", the first alternative health report. This alternative report, which was started on the basis that civil society needs to produce its own global health report unfettered by political restrictions, challenges the relevance of the WHO World Health Reports.

Although there is a need to invest in building the evidence base around the role of policy, and, in particular, finding the appropriate tools for evaluating a policy's impact, there is clearly a convergence of opinion that it is time to enact policies aimed at creating healthier social and physical environments. This opinion is accompanied by an emerging trend to return to not only the concept but the reality of community: where we live and the types of societies we want. Governments have the classic tools of legislation, regulation, and taxation at their disposal to enact social policies that can serve to turn the tide of CVD, diabetes, obesity, and other chronic conditions. Thanks to the growing and increasingly concerted voices of lobby groups, governments are beginning to take this role more seriously.

The major modifiable risk factors for CVD, smoking, high serum cholesterol, high blood pressure, physical inactivity, obesity and diabetes have shown non-uniform trends; some risk factors have diminished, some increased. Many of those changes are related to changes in society and environment. Smoking is an excellent example, and the food industry and catering has also significantly contributed to the dramatic decrease in CVD mortality in the middle-aged populations in most developed countries. For instance, in Finland CVD mortality has fallen over 70% during the past 40 years in middle-aged men. The epidemiological analysis of the data unequivocally shows that this has mainly happened thanks to improvements in smoking habits, serum cholesterol and blood pressure. These improvements have taken place across the entire population, not only in high risk individuals cared by health sector. Thus, there is no doubt that societal changes have been primarily behind the prevention of premature CVD in this country and many other countries as well. It is important that health sector together with other policies will have a common goal: getting healthier choices in lifestyles and environments easier to adopt and maintain. Increased investments in these areas will bring both health and financial gains in the longer term.

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