America’s heart problem is now the World’s
Heart disease is no longer an American problem
World Health Day is a global health awareness day celebrated every year on April 7th, under the sponsorship of the World Health Organization (WHO), to call attention to the advancement of health in all people. This year, I sat down with Dr. Brion Winston, who in addition to being a board-certified cardiologist, also has an area of interest in public health. Our discussion began with data from WHO that in 2016, more people died of heart disease than of AIDS/HIV, malaria, and tuberculosis. Heart disease is responsible for one-third of all global deaths.
Why is heart disease exploding in developing countries?
At least three-quarters of the world’s deaths from cardiovascular disease (CVD), or heart disease, occur in low- and middle-income countries. Heart disease very treatable and preventable if caught early. One factor affecting the poorest people in these places is the lack of detection. Dr. Winston explained how the diagnostic evaluation of heart disease in developing countries would be pretty basic, at best. “You would be able to find electrocardiography in many clinics but remember, in poor and developing nations, the standard of health care delivery is often a fee for service. If someone has a severe health problem, they will show up to the emergency department, often accompanied by their family, they will talk with the doctor and the patient. The doctor will say, ‘this is what I think is going on, and this is what it will cost’ and there is a fee for service right up front. With that in mind, the choices for diagnostic evaluation may be limited in some places.”
“Taking to the later phases of treatment, surgical treatment for heart disease in poorer nations are quite limited, maybe to aspirin, things like catheterization labs – you’ll find poorer countries don’t have them,” stated Dr. Winston. Treatment and procedures of heart disease like balloon angioplasty (where a small balloon-like device is threaded through an artery to open the blockage), coronary artery bypass or valve repair and replacement is costly once heart disease advances. “But, with the example of India, they have many hospitals which have prospered with the economic development over the last 30 years, these sites are considered ‘medical tourism’ where Americans will travel overseas for heart procedures in India. These are for-profit hospitals that run efficiently, conducting a high volume of surgical procedures. The costs of some of these procedures would be a fraction of what a patient would pay and there are some people willing to travel for this.”
Awareness and education are an important component that is missing in developing countries. The most important behavioral risk factors of heart disease and stroke are an unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. Americans are bombarded with public health messages informing us of the increased risks of a poor diet, smoking, and lack of exercise; this is not the case in other parts of the world. “In my practice and taking with my colleagues, many of whom are from South Asia (India and Pakistan), there is a high incidence of heart disease in people from these lands when they come to the US, if they follow a US diet that is high in fat, then we may see development of heart disease even earlier,” says Dr. Winston. “Overall, while we have made substantial improvements in reducing smoking in the United States but in South Asia and China, there is still a large amount of that population that still smokes, combine that with a richer diet – that will add to this problem as well.”
A “better life” might be a slow killer
Economics is an underlying cause of fostering the bad behavior that leads to heart disease. In some countries, soda is cheaper than bottled water. This year, Canada recently updated its Food Guide to offer advice on what to eat, what not to eat, and how to eat. Half of the plate is fruits and vegetables, a quarter for whole grain foods, the final quarter for protein. They also removed dairy as a category, urging citizens to have a glass of water with meals. In the African nations of Tanzania and Zambia, clean water does not flow from their taps. A can of Coke is less than and safer than clean water. This choice adds up; according to the Human Sciences Research Council the cost of eating healthy in South Africa is 69% more than the alternative.
The opposite is true in other parts of the world. “As standards of living have improved in South Asia as well as in China, people are following more of what we tend to think of as a Western Diet, a high fat, high energy diet – we rating to see more diabetes and related heart disease. It’s both an issue that we have made progress of infectious disease as well as the economic shift which has lead to people eating richer diets putting them at greater risk for heart disease,” notes Dr. Winston.
A global problem
Heart disease is the number one killer of men and women in America. It is also responsible for one-third of all global deaths. This global problem is going to need a large solution that addresses access to health care and preventative treatment. A WHO report estimates that Africa has about one doctor for every 5000 people. In underdeveloped nations, community health care workers fill the void of serving patient’s who don’t have access to a doctor or even a hospital. In South Africa, Mexico, and Guatemala, a study shows that these health care workers were able to screen adults for cardiovascular disease when access to a physician was not available. Armed with a mobile app, instead of traditional paper, these volunteer professionals were able to diagnose patients efficiently and at less cost compared to standard care.
There is hope in solving the global heart health problem. While there will certainly be a growing demand for cardiologists worldwide, it wasn’t that long ago that the HIV/AIDS crisis seemed impossible to contain. Money for research, governments pushing for public health policies, and dedicated medical professionals will need to unite around the world to fight heart disease – together.
Written by: Michael Arce, Capital Cardiology Associates Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.