The global cardiovascular diseases (CVD) burden is growing. Deaths due to CVD grew by one quarter since 2000, reaching 17.9 million in 2019. Each year, more than 15 million people between the ages of 30 and 69 die prematurely from CVD and other Noncommunicable Diseases (NCD). Moreover, 85% of these premature deaths occur in low-and -middle-income countries where financial and human resource constraints are growing due to the impact of the COVID-19 pandemic and other global crises.

Nearly 80% of premature deaths due to CVD can be prevented through 1) public health policies to reduce behavioural risk factors 2) detection and integrated management of hypertension and diabetes utilising a primary health care approach and 3) secondary prevention of heart attacks and strokes. Although these interventions are affordable to all countries, only 14 countries are on track to reach the global Sustainable Development Goal (SDG) of reducing premature deaths due to NCDs by one third by 2030.

All countries can make progress towards the SDG target by prioritizing the above strategies in national NCD portfolios. In 2011, to inform Heads of State and Governments at the first United Nations High-Level Meeting on NCDs, the World Health Organization identified a set of very cost-effective interventions which provide affordable options to all countries: the best buys. They cover six policy areas: tobacco use, harmful use of alcohol, promotion of healthy diet and physical activity, CVD and diabetes and cervical cancer. There are 16 targeted interventions within these areas, 14 of which address CVD through population-wide primary prevention, individual primary prevention and secondary prevention. Both the individual primary prevention and secondary prevention of CVD are through the implementation of a total cardiovascular risk approach in primary health care using hypertension and diabetes as entry points. Estimates show that an investment of US$ 0.84 per person per year on best buy interventions between now and 2030 could avert 10 million heart attacks and strokes, save 7 million lives and realize more than US$ 230 billion in economic and societal benefits: an impressive return on investment. The already unbearable financial burden of health care costs can be minimized in all countries by accelerating prevention of CVD.

What are the political, commercial, structural and contextual factors that impede the uptake of affordable and sustainable interventions for CVD prevention and what can be done to modify them?
How can CVD and NCD prevention be prioritized, despite the prevailing capacity and system challenges in resource-constrained settings.

Research areas and perspectives within this topic may include:
1) Understanding the processes that maintain the unsustainable status quo and incentives for reform and adoption of preventative CVD interventions including best buys.
2) Stakeholder analysis on overt promotion of tobacco and fast food, covert political lobbying by parties with vested interests and inadvertent policy and bureaucratic barriers which impede progress.
3) Analysing policies, processes, and institutional structures that prevent the implementation of health promotion strategies with concrete and pragmatic proposals for change.
4) Insights into processes that facilitate multi-sectoral collaboration and policy coherence to reduce tobacco use and harmful alcohol use and prevent obesity and diabetes through physical activity and a healthy diet.
5) Identifying and showcasing effective strategies to tackle barriers to integration of CVD prevention in basic benefit packages in universal health coverage initiatives.

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Frontiers in Cardiovascular Medicine

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