Ernest Madu Chairman & CEO The Heart Institute of the Caribbean
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Innovative Solutions for Sustainable, Affordable & Accessible Good Quality Healthcare Globally
Cardiovascular diseases (CVD) were responsible for less than 10 percent of all global deaths at the dawn of the 20th century. By 2001, CVDs were responsible for about 30 percent of all deaths worldwide, fuelled mainly by the rapid rise in the epidemic of cardiovascular diseases in low and middle-income countries. According to the World Health Organization (WHO), 17 million deaths occur annually from cardiovascular diseases accounting for one-third of all global deaths. Currently, an estimated 80 percent of the global mortality and disease burden from cardiovascular diseases occur in developing countries — a reflection of the evolving and shifting pattern of the burden of the global CVD epidemic. Twice as many deaths now occur yearly in developing countries from CVD compared to more developed countries. Ironically, the countries with limited resources and capacity are also the ones experiencing the greatest burden of cardiovascular diseases.
In Sub-Saharan Africa, for example, deaths attributable to CVD are projected to more than double between the years 1990 and 2020. Available data suggests that by 2015, the number of deaths from non-communicable diseases in Africa will exceed those due to communicable diseases. The majority of these shifts will occur in the emerging global CVD pandemic. By year 2020, the CVD mortality prevalence rate in sub-Saharan Africa will increase by 134 percent in men and by 126 percent in women. In Latin America and the Caribbean, CVD accounted for about 31 percent of all deaths in 2001, but that figure is expected to rise to 38 percent by 2020. India is also experiencing an alarming increase in heart diseases. The World Health Organization estimates that more than 50 percent of the world’s cardiac patients may currently reside in India.
The rising prevalence of cardiovascular diseases in developing countries seems to be linked to changes in lifestyle and diet, rapid urbanization and increase in the prevalence of traditional cardiac risk factors like obesity, hypertension, diabetes and smoking in these countries. By 2025, prevalence rates for diabetes mellitus in developing countries will increase by 170 percent, from 84 million to 228 million, or about 70 percent of the global burden of diabetes. Available data suggest that diabetes and cardiovascular disease will account for about 1 million deaths annually in Latin America representing over 25 percent of all deaths, affecting an equal number of men and women. Of the estimated 1.1 billion smokers worldwide, more than 800 million are in developing countries with the African region experiencing the fastest rise in smoking rates at 4.3 percent per year.
The economic impact of cardiovascular diseases in developing economies is devastating, largely because working-age adults account for a high proportion of the CVD burden. In the Caribbean and South America, diabetes and cardiovascular disease will be responsible for 3 times more deaths and disability by 2025, affecting mainly individuals in their mid-life years, disrupting the future of families, undermining social structures and depriving nations of workers in their most productive years, thus precipitating economic decline and underdevelopment. It is estimated that each year, at least 21 million years of future productive life are lost in Brazil, China, India, Mexico and South Africa because of CVD. In South Africa, the direct costs for treatment of CVD were equivalent to about 3 percent of the gross domestic product, or the equivalent of 25 percent of all health care expenditures. The demand for effective care for cardiovascular diseases will exert major economic pressure on health systems in developing countries in the years ahead and will further threaten social order and structures in these countries, unless innovative and ingenious approaches are identified to mitigate the circumstances.
Even though major technological advances have been made available, most of the interventions needed to address cardiovascular diseases are currently not readily available to developing countries because they are expensive, unaffordable and often complex and not adaptable to these countries. Despite the need, increased use of these procedures is further limited by absence of trained personnel and therefore inaccessible to those who need it the most.
This should not be the case. The ultimate value of quality healthcare hinges on access, which, in low resource nations, is primarily determined by affordability and availability. In order to bridge the accessibility gap between the rich and poor nations of the world, the poorer nations must be granted access to modern technology through provision of affordable and sustainable technology solutions that are appropriate and adaptable to their environment. It is not only the right thing to do; it also makes good business sense considering the disease prevalence. The inability of healthcare companies and other stakeholders to innovate and create affordable and adaptable technology platforms in response to the changing demography of cardiovascular diseases is a reflection of flawed and unimaginative thinking.
The epidemiologic transition taking place in developing countries with a rising tide of cardiovascular diseases presents a unique opportunity for innovative thinking to create affordable and sustainable solutions to meet the demand in these countries. This requires rethinking of our current mode of operation and smart use of technology, leveraging technological advances to take advantage of new market opportunities. Could this be the healthymagination being touted by GE? Imagine the economic and social possibilities that would be unleashed if advanced medical technology could be re-engineered or re-imagined to create affordable solutions for low resource nations while simultaneously reordering the educational and training curriculum to produce the requisite skill sets needed to boost internal capacity in these countries. It is a healthy imagination that can indeed be realized; but only if we dare to think differently, think boldly and imaginatively, but above all have the courage to recognize that the world is changing and the change brings new opportunities far from the usual traditional comfort zones.
This is the concept that underlies our mission at the Heart Institute of the Caribbean, where we have shown that with careful planning, smart design, and appropriate use of technology — while concurrently boosting internal capacity through training and skills transfer — sustainable and affordable high-quality cardiovascular care, anchored on aggressive prevention and treatment strategies, can indeed become a reality in low-resource economies. It is an example that can and should be replicated.
