Abstract
Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. We summarise the key findings and present a costed essential package of interventions to reduce risk of and manage CVRDs. On a population level, we recommend tobacco taxation, bans on trans fats, and compulsory reduction of salt in manufactured food products. We suggest primary health services be strengthened through the establishment of locally endorsed guidelines and ensured availability of essential medications. The policy interventions and health service delivery package we suggest could serve as the cornerstone for the management of CVRDs, and afford substantial financial risk protection for vulnerable households. We estimate that full implementation of the essential package would cost an additional US$21 per person in the average low-income country and $24 in the average lower-middle-income country. The essential package we describe could be a starting place for low-income and middle-income countries developing universal health coverage packages. Interventions could be rolled out as disease burden demands and budgets allow. Our outlined interventions provide a pathway for countries attempting to convert the UN Sustainable Development Goal commitments into tangible action.
Original language | English |
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Pages (from-to) | 1224-1236 |
Number of pages | 13 |
Journal | The Lancet |
Volume | 391 |
Issue number | 10126 |
DOIs | |
Publication status | Published - Mar 24 2018 |
Bibliographical note
Publisher Copyright:© 2018 Elsevier Ltd
Funding
DP, RN, and DW received funding from the Bill & Melinda Gates Foundation in support of this work. Outside the submitted work, DP's institutions (Public Health Foundation of India and Centre for Chronic Disease Control) have received grants for chronic disease research and capacity building from multiple sources, including international research funding bodies, government agencies, foundations, United Health and multiple pharmaceutical industries, such as MSD, Johnson and Johnson, Sun Pharmaceuticals, and GlaxoSmithKline. SA is supported by the NIDDK K-23 5K23DK101826-03. DW reports grants from Medtronic Foundation and the American Heart Association, outside the submitted work. TG has received grants for cardiovascular disease research to Brigham and Women's Hospital from Novartis and United HealthCare Services, outside the submitted work. YF and JCM declare no competing interests.
Funders | Funder number |
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National Institute of Diabetes and Digestive and Kidney Diseases | K23DK101826 |
Bill and Melinda Gates Foundation | |
American Heart Association | |
Medtronic Foundation |
ASJC Scopus Subject Areas
- General Medicine