SEAHEARTS: Accelerating prevention and control of cardiovascular diseases in the South-East Asia Region – Dhaka Call to Action

Abstract

Cardiovascular diseases (‎CVD)‎ are the leading cause of deaths accounting for nearly 30%(‎3.9 million)‎ of the total number of 13.2 million deaths in the South-East Asia Region in 2021. Most of CVD deaths occur prematurely among individuals between the ages of 30 and 69 years. Tobacco use, alcohol consumption, unhealthy diet, physical inactivity, high blood pressure and raised blood glucose are the major risk factors.Countries in the Region have implemented a range of ‘best buys’ steered by the Regional Noncommunicable Disease (‎NCD)‎ Flagship Priority and had contributed to the reduction of age-adjusted premature mortality (‎for men and women combined)‎ from CVDs from 129 per 100 000 in 2000 to 108 per 100 000 in 2019. However, the rate of decline is uneven across countries and not sufficient to achieve the Regional NCD targets and SDG 3.4 target for 2030. More than 245 million people in the Region aged above 30 years have hypertension, and approximately 100 million adults are living with diabetes, with an estimated half of these individuals not aware of their conditions. The Regional Committee in 2022 endorsed the ‘Implementation Roadmap for accelerating the prevention and control of noncommunicable diseases in South-East Asia 2022–2030’ (‎SEA/RC75/R2)‎. A Regional Workshop for implementing the WHO South-East Asia NCD Roadmap 2022–2030 was held on 12–15 June 2023 in Dhaka, Bangladesh.1 Member States of the WHO South-East Asia Region participated in the workshop, the outcome of which was the ‘Dhaka Call to Action – Accelerating the control of cardiovascular diseases in a quarter of the world’s population’ (‎Annexure 1)‎. The Call to Action represents a set of prioritized actions and interim milestones that are based on the SEAHEARTS Initiative.2SEAHEARTS brings together efforts made for risk factor reduction (‎tobacco control, saltreduction and eliminating industrially produced trans-fatty acids)‎ and improving hypertension and diabetes treatment cascade in the broader context of NCD prevention and control. The Call to Action emphasizes the accelerated implementation of WHO technical packages – WHO HEARTS (‎technical package for CVD management in primary health care)‎, WHO MPOWER (‎measures to reduce the demand for tobacco, contained in the WHO Framework Convention on Tobacco Control)‎, WHO SHAKE (‎technical package for salt reduction)‎ and WHO REPLACE (‎technical package for eliminating industrial produced trans fatty acids)‎ within the local context settings to reduce the incidence and outcomes of CVD. Member States may consider endorsing the ‘Dhaka Call to Action’ for accelerating the control of cardiovascular diseases in the Region. Countries can sustain and scale up the gains achieved in tobacco control and progress on salt reduction and trans-fatty acids elimination. Health system strengthening measures focusing on primary health care can help to expand coverage and control of hypertension and diabetes. WHO will provide advocacy and technical support to Member States to develop and prioritize national efforts to accelerate the implementation of the ‘Dhaka Call to Action’ following endorsement. Documenting good practices, successful interventions, innovative approaches and lessons learnt in implementing the ‘Dhaka Call to Action’ along with monitoring and evaluation of its progress will be the essential features of the support provided by WHO. With the deadline for SDG targets only a few years away, the Region needs to consistently sustain, accelerate and innovate CVD interventions towards achieving the targets on NCDs as well as universal health coverage. The attached Working Paper was presented to the High-Level Preparatory (‎HLP)‎ Meeting for its review and recommendations. The HLP Meeting reviewed the paper and made the following recommendations for consideration by the Seventy-sixth Session of the Regional Committee: Actions by Member States(‎1)‎ Consider endorsing the ‘Dhaka Call to Action: Accelerating the control of cardiovascular diseases in a quarter of the world’s population’. (‎2)‎ Implement the SEAHEARTS initiative to sustain and expand the gains achieved by implementing WHO HEARTS, MPOWER, SHAKE, REPLACE, and other technical packages to achieve the interim milestones of the Dhaka Call to Action. (‎3)‎ Strengthen political commitment and leadership, along with adequate capacity in the health systems and promote accountability through timely and reliable data Actions by WHO(‎1)‎ Support Member States to develop and prioritize country-specific roadmaps with baseline and targets to accelerate the implementation of the Dhaka Call to Action and achieve the interim milestones through the SEAHEARTS initiative. (‎2)‎ Support Member States to leverage legislative, regulatory, and fiscal policies and other measures to reduce risk factors for CVDs. (‎3)‎ Provide technical support in monitoring and evaluation, documenting good practices, and lessons learnt in implementing the Dhaka Call to Action.This Working Paper and the HLP Meeting recommendations are submitted to the Seventy-sixth Session of the WHO Regional Committee for South-East Asia for its consideration and decision.