The consensus opinion of the four panelists – Sir Michael Marmot, Martin Bobak, Pekka Puska and Valentin Fuster – was that cardiologists must push to make the “galloping” global epidemic of cardiovascular disease a priority of health policymakers. Dr Fuster particularly lamented the United Nations’ failure to specify cardiovascular disease among its health-related Millennium Development Goals.
“We cannot be ignored by policymakers,” said Dr Fuster. “If we are, then we’ll have limited funds for limited action.”
“Cardiologists must become policymakers,” said Sir Michael.
Dr Puska emphasised that success in raising the epidemic’s public health profile would depend on the ability to present evidence that failure to address the epidemic would have profound economic consequences. “We cannot sell our health policies if we do not have the economic argument,” Dr Puska said.
Sir Michael stressed that cardiologists must look beyond the traditional risk factors of poor diet, physical inactivity, tobacco smoking and high blood pressure. They must consider also the social determinants of health, such as income, education, work circumstances, quality of neighbourhoods and early life development -- that is, what his colleague Dr Bobak called “the upstream determinants of the global cardiovascular disease epidemic”.
The panellists were optimistic that they would succeed. Pointing to the exemplary experience of Finland, Dr Puska said, “Major changes in population rates can take place in a surprisingly short time.” Added Dr Fuster, referring to the speed with which the obesity epidemic developed in the United States, “If it happened in 10 years, why can it not be reversed [as quickly]?” Mentioning the positive reception to his many recent editorials in influential medical journals, Dr Fuster said, “I have the feeling it’s the right moment. Something is evolving, is boiling that I think is going to click.”
Sir Michael joined his colleagues in emphasising the need for action and said that the World Health Organization’s report on the social determinants of health, which is expected in April 2008, would provide tangible recommendations based on actions that countries are taking to consider social determinates in the formulation of health policy.