Addressing cardiovascular disease at EU level: tangible plans for the future. Hübel M. Conference on Cardiovascular Diseases (Madrid: Ministry of Health and Social Policy; 2010).

1. Cardiovascular diseases:
A European Commission
Perspective
Michael Hübel
European Commission, DG Health
and Consumers

2. CVD – largest single cause of death in EU
Ischaemic heart diseases and cerebrovascular diseases
as percentages of total death rates 2006
50,0%
45,0%
40,0%
35,0%
30,0%
25,0%
20,0%
15,0%
10,0%
5,0%
0,0%
bg cz dk de ee ie el es fr it cy lv lt lu hu mt nl at pl pt ro si sk fi se uk
Ischaemic heart diseases (I20-I25) Cerebrovascular diseases (I60-I69)

3. More than 2 fold difference in death rates
between EU Regions
Source: atlas of
mortality in the
European
Union. Eurostat
2009

4. Higher risk of CVD for poor and less well educated

5. 20-50% decline in CVD mortality since 1980
S D R , dis eas es of c irc ulatory
s ys tem , all ages per 100000
700
600
500
400
EU
EU m em bers before May 2004
EU m em bers s ince 2004 or 2007
300
200
100
Source WHO HFA
Database 2009 –
standardised death rates
all ages
0
1970 1980 1990 2000

6. Common determinants of CVD and other non
communicable diseases
Social and economic situation
Unhealthy Physical Tobacco Alcohol
diet inactivity use
CVD Cancer Type 2 COPD Mental Musculoskeletal Oral
diabetes health disorders health
Environmental qualitynon-communicable disease
Figure: Causal factors of major

7. % of deaths caused by key risk factors
20
18
16
14
12
10
8
6
4
2
0
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Source: Global health risks: mortality and disease attributable to selected health risks. WHO 2009, table 1 – high income countries

8. EU Action on CVD and other chronic
diseases.
Overall approach – the EU Health Strategy, EU2020
Determinants – socio­economic, environmental, behavioural
Partnership with MS and Stakeholders
Values – equity, health is wealth,
Health in All Policies
EU initiatives – health inequalities, environment and
health, tobacco, nutrition, physical activity, alcohol,
mental health
Specific CVD activities, MS, Stakeholders, Indicators,
Research
Emerging chronic disease alliance

9. Socio­economic determinants –
“Solidarity in Health” COM(2009)567
Strengthen collaboration with Member States,
Regions and other Stakeholders
“A fair distribution of health as part of overall
social and economic development”
Improve measurement and knowledge
Health inequality policy audit
Action for vulnerable groups – Roma, migrants
Use of structural, cohesion, rural development
Use PROGRESS, Health Programme and other
funds
Initiative on global health

10. Broader health determinants

11. Tobacco
Legislation
Advertising, Warning messages and pictures
Products
Smoke free environments
Link to international work (FCTC)
Prevention work: Youth campaigns
2002­2004: ‘Feel free to say no’
2005­2008: ‘HELP’ ­ 72 Mio €/4 years
2009­2010: HELP 2.0 – 32 Mio €/2 years
Network tobacco control initiatives
Exchange Best Practice and develop European
projects

12. Developing New partnerships:
Nutrition and Physical Activity
Alarming rates of obesity in particular in young people –
diet/activity key health determinants
EU role in food law (labelling, health claims) ­
agriculture, education, transport, taxation…
Consumer information, advertising and marketing
Develop new partnerships
2004: Roundtable on Obesity
2005: Platform on Diet, Physical Activity and Health
A new strategy
2005: Green Paper (consultation)
2006: White Paper on Nutrition and Physical Activity
2007: High Level Group – 2008:Salt initiative 2009: Fat and
sugar reformulation

13. Alcohol
2006: Communication on alcohol­related harm
Young people and children
Road traffic and drink driving
Adults and the workplace
Information and awareness raising
Evidence base
Work across policies and with Member States
2007: Alcohol and Health Forum
100+ commitments for action
Annual Open Forum meetings

14. Mental health
October 2005: Green paper consultation – open
and structured
December 2007: New departure
2008 European Pact and high level conference
Suicide and depression
Young people and education
Workplace
The elderly
Stigma and discrimination
2009­11 Thematic conferences on priority
themes

15. CVD specific activities
Member States, Council
Stakeholders –
European Heart Health Charter
Health Programme Funding
Indicators
Research

16. Council Conclusions on heart health –
June 2004
encourage networking and the exchange of
information between stakeholders
strengthen the comparability of data
European food and nutrition policy, to include,
physical activity
take a multisectoral approach to preventing
cardiovascular disease and assessing the health
impact of other public policies of the European
Union;
co­operate with the relevant international and
inter­governmental organisations, in particular
the World Health Organisation

17. Commitments on Heart Health
Luxembourg declaration (2005):
Necessity for comprehensive
strategies
Heart Health Charter
Cooperation cardiologists – heart
networks key success factor

18. EU Heart Health Charter
Principles
Policies
EU Heart National
National
Health Heart
National
Heartional
Na
Charter Health
Heart
Health
Heart
Strategies
Health
Strategies
Health
Strategies
Stakeholders Strategies
Monitoring

19. Facilitate and support national
strategies – Bottom­up approach
Heart Health Charter development
process – consensus building process
among stakeholders
Mobilisation in Member States key
Primary carers/health professionals as
actors in prevention and health
promotion
Build partnerships: determinants,
diseases, screening, treatment?

20. Health systems
Emerging cooperation between
Member States
The example of cancer screening
Patient Mobility Directive
Structured cooperation between
Member States

21. Indicators and statistics
Responding to the need of comparable indicators for
cardiovascular diseases monitoring
EUROCISS 1 ­ Cardiovascular Indicators surveillance set
in Europe (Phases 1, 2)
Cardiology Audit and Registration Data Standards
(CARDS) project
Responding to the need of comparable incidence data for
coronary events
European Cardiovascular Disease Statistics ­ European
Heart Network
Responding to the need of cardiovascular mortality
comparable data
Eurostat Atlas of Mortality: cardiovascular diseases

22. Indicators ­ cont
EUROCISS 2 ­ Cardiovascular Indicators surveillance set
in Europe (Phase 2) Project ­ 2008
to define indicators for monitoring CVD
to recommend standardized methods for collecting
indicators in EU countries
to prepare manuals of operations describing in detail
procedures and methods for easy implementation of
population­based registers and CVD surveys.
The achievement of EUROCISS 2 aims
will facilitate cross­country comparisons and
Will assist efforts to improve the prevention and control of
CVD.

23. Research projects FP6/FP7
Integrated Project focusing on the genomics
of atherothrombosis
Network of Excellence in vascular biology
Integrated Project on signalling molecules
involved in disease mechanisms
Towards the stabilisation of atheromatous plaque
Genetics of Thrombotic Stroke
Cell Transplantation for Myocardial Repair
Adult Stem Cell Research

24. Projects from the Health Programmes
Children, obesity and associated avoidable chronic diseases
(European Heart Network)
European Mapping of Obesity Best practice (Learning Lab
Denmark)
Development & Implementation of a European Guideline and
training standards for Diabetes Prevention (Technische
Universität Dresden, Medizinische Fakultät Carl Gustav)
Promotion of vegetable and fruit consumption of school children
(Karolinska Institute)
Building Policy Capacities for Health Promotion through Physical
Activity among Sedentary Older People (Univ. Erlangen)
Move Europe ­ a Campaign for the Improvement of Lifestyle­
related Workplace Health Promotion in Europe (European
Network for Workplace Health Promotion)
Shape Up – towards a European network for obesity prevention
in children (PaU Education, Barcelona)

25. A chronic­diseases alliance
Ad­hoc alliance of medical & health
promotion organisations
Aiming at producing a policy document:
Underlining the NCD challenge
addressing common health determinants (tobacco,
nutrition, physical activity, alcohol);
Developing a set of joint life­style
recommendations;
targeting EU policy makers;
to be shared with the Belgian Presidency for their
planned conference on chronic diseases (October
2010);
to be ready by spring 2010