This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (5) Citing Articles via Google Scholar Google Scholar Articles by Joshi, R. Articles by MacMahon, S. Search for Related Content PubMed PubMed Citation Articles by Joshi, R. Articles by MacMahon, S. Related Collections Related Article

STATE-OF-THE-ART PAPER

Global Inequalities in Access to Cardiovascular Health Care

Our Greatest Challenge

Rohina Joshi, MBBS, MPH, PhD^_*,_*, Stephen Jan, MEc, PhD^_*, Yangfeng Wu, MD, PhD and Stephen MacMahon, DSc, PhD, FACC, FAHA, FCSANZ^_*

^_* The George Institute for International Health, Faculty of Medicine, University of Sydney, Sydney, Australia
The George Institute China, Department of Epidemiology, School of Public Health, Peking University, Peking, China

Manuscript received May 16, 2008; revised manuscript received July 31, 2008, accepted August 5, 2008.

^_* Reprint requests and correspondence: Dr. Rohina Joshi, The George Institute for International Health, University of Sydney, P.O. Box M201, Missenden Road, Sydney, NSW 2050, Australia (Email: rjoshi{at}thegeorgeinstitute.org).

Cardiovascular disease (CVD) was the leading cause of death globally in 2005, responsible for 17.5 million deaths, more than 80% of which occurred in low- and middle-income countries (LMIC). In these regions, CVD occurs at a much younger age than in high-income countries, thereby contributing disproportionately to lost potential years of healthy life as well as lost economic productivity. Many effective interventions for CVD prevention and management are now affordable for all but the very poorest countries, but large treatment gaps still exist because of poor prescribing practices, limited availability of medicines, and lack of appropriately skilled health care providers. Despite the increasing awareness of the growing epidemic of CVD in LMIC, this public health priority has received little attention from those who determine the international health agenda. Although the burden of CVD is already enormous in developing countries, there exists a window of opportunity to prevent the epidemic reaching its full potential magnitude. This requires the rapid deployment of strategies already proven to be effective in high-income countries. Such strategies need to be tailored for LMIC for them to be affordable, effective, and accessible to disadvantaged groups and the burgeoning middle classes. Ideally, the control of CVD in these countries would involve a dual approach in which evidence-based clinical strategies for CVD prevention and treatment are complemented by evidence-based population level strategies. We propose that upgrading primary health care services is a central requirement for the control of the CVD epidemics facing the developing world.

Key Words: cardiovascular health care • global inequalities • primary health care • evidence-based treatment

Abbreviations and Acronyms   CVD = cardiovascular disease   DALYS = disability-adjusted life years   GDP = gross domestic product   LMIC = low- and middle-income countries   WHO = World Health Organization

Related Article

Inside This Issue of JACC
J. Am. Coll. Cardiol. 2008 52: A40. [Full Text] [PDF]

This article has been cited by other articles:

				T. S. Baman, A. Romero, J. N. Kirkpatrick, J. Romero, D. C. Lange, E. O. Sison, R. V. Tangco, N. S. Abelardo, G. Samson, R. Grezlik, et al. Safety and efficacy of pacemaker reuse in underdeveloped nations a case series. J. Am. Coll. Cardiol., October 13, 2009; 54(16): 1557 - 1558. [Full Text] [PDF]

				A. Damasceno, A. Azevedo, C. Silva-Matos, A. Prista, D. Diogo, and N. Lunet Hypertension Prevalence, Awareness, Treatment, and Control in Mozambique: Urban/Rural Gap During Epidemiological Transition Hypertension, July 1, 2009; 54(1): 77 - 83. [Abstract] [Full Text] [PDF]

				F. Aslam and A. Waheed Aspirin for the masses. J. Am. Coll. Cardiol., June 30, 2009; 54(1): 91 - 91. [Full Text] [PDF]

				R. Joshi, S. Jan, Y. Wu, and S. MacMahon Reply. J. Am. Coll. Cardiol., June 30, 2009; 54(1): 91 - 92. [Full Text] [PDF]

				R. Joshi, C. K. Chow, P. K. Raju, R. Raju, K. S. Reddy, S. MacMahon, A. D. Lopez, and B. Neal Fatal and Nonfatal Cardiovascular Disease and the Use of Therapies for Secondary Prevention in a Rural Region of India Circulation, April 14, 2009; 119(14): 1950 - 1955. [Abstract] [Full Text] [PDF]