Our health is inextricably linked to our fast-changing environment. As the physical and socio-cultural landscape of South-East Asia transforms due to growing economies, rapid urbanization and globalization, the public health landscape is changing too. Conditions such as hypertension (high blood pressure) cardiovascular diseases, diabetes and related illnesses have seen a spiralling surge in this region and in other developing countries, as people no longer have the time or space to exercise, can no longer easily obtain and consume fresh, healthy food, and are cut off from their traditional social support systems.
High blood pressure can be prevented through simple lifestyle changes. Yet it is now the single-most important risk factor for mortality, accounting for 1 in every 10 deaths in South-East Asia. It increases the risk of heart attack, stroke, and kidney failure, often in the productive years of life. The cost of healthcare, premature death, disability, and loss of income, can devastate families and national exchequers. During 2011–2015, the cumulative lost output in low- and middle-income countries associated with non-communicable diseases is projected to be US$7.3 trillion. The human cost, though, is incalculable.
Preventing high blood pressure should therefore not only be a public health priority, but also a social, economic and development priority. Member States have agreed to nine global targets for prevention and control of non-communicable diseases, which include reducing the prevalence of hypertension by 25 per cent by 2025. This is only possible with increased public awareness and cooperation. To help achieve this WHO has dedicated the theme of World Health Day 2013 to “high blood pressure”.
The increasing prevalence of hypertension is attributed to population growth, ageing, and behaviours such as unhealthy diet, tobacco use, lack of physical activity, excess weight, harmful use of alcohol, and exposure to persistent stress. Preventing, detecting and treating hypertension early is far cheaper than interventions such as cardiac bypass surgery or dialysis that may be needed if the condition is diagnosed late when complications have set in. Yet very few people are aware they may have high blood pressure, because it is an “invisible killer”, frequently showing no symptoms. The experience of high-income countries has shown that early detection and treatment of hypertension, as well as public health policies that reduce exposure to behavioral risk factors, lead to decline in mortality due to heart disease and stroke. This is particularly important for our region because most countries can ill afford the escalating medical-care costs of chronic diseases.
Acknowledging this as a serious global issue, in September 2011, the United Nations General Assembly adopted the Political Declaration of the High-Level Meeting on the Prevention and Control of Non-communicable Diseases, and committed governments to a series of actions.
The World Health Organization is now developing a global plan of action for 2013–2020 for the prevention and control of non-communicable diseases. WHO has produced evidence-based guidelines and tools for prevention and control of non-communicable diseases focusing on prevention of behavioral risk factors and early diagnosis and treatment of high blood pressure. WHO is also assisting countries to develop action plans and set national targets to track progress in preventing and controlling such diseases, including hypertension, and their key risk factors.
Hypertension and related non-communicable diseases cannot be dealt with by the health sector alone – they require “whole of government” and “whole of society” approaches. At the government level, education and labour, food and nutrition, transport and communications, urban development, sports and youth affairs all need to come together to design interventions and create health promoting environments that will encourage as well as enable people to adopt healthy lifestyles. This includes emphasis on urban spaces for physical activity and even just walking, programmes on healthy eating and fitness in schools. It also means working with the food industry, putting regulations in place for decreasing the amount of salt in packaged food, and increasing the availability and affordability of healthier food options.
Preventing high blood pressure needs the involvement and support of all of society. The private sector as well as businesses and organizations (concerned about their employees), academia, and various stakeholder communities need to collaborate to create an enabling environment for leading healthier lifestyles. At the same time, health systems need to ensure access to services for people to be easily diagnosed and treated early for high blood pressure.Finally, each individual and family has to take responsibility to prevent hypertension – by eating a balanced diet, reducing salt, getting regular exercise, avoiding harmful use of alcohol and shunning tobacco, by checking their blood pressure regularly for diagnosis and treatment, and by supporting others. Our health, our lives and indeed our future depend on it.
Dr Plianbangchang is WHO Regional Director for South-East Asia