Prevalence of CVD and CHD in the UK

The mortality and mortality associated with cardiovascular disease (CVD) is increasing globally. CVD is regarded as the number 1 cause of death globally. The review of latest 2015 global CVD death statistics suggest about 17.7 million death caused due to CVD. This means that CVD was the reason for about 31% of global death. CVD is an umbrella term for different types of heart disease and coronary heart disease is one of the major type of CVD, which has caused about 7.4 million deaths in 2015 (World Health Organization 2015). Hence, from this statistics, it is understood that coronary heart disease (CHD) significantly contributes to total deaths globally. The CVD related deaths caused in UK is also alarming as latest reports have shown that CVD causes more than 25% of all deaths in UK and about 7 million people are living with the disease in UK. Among CVDs, CHD has been found to be the leading cause of death in UK (Bhf.org.uk. 2016). Considering such prevalence of coronary heart disease in UK, the main purpose of this essay is to identify six articles related to the incidence and management of CHD in UK and explore in depth about the ways in which the disease was managed.  The paper also explores range of framework, policy approach and intervention that can be effective in reducing the risk of CHD in UK. After the evaluation of the articles, the paper also proposes a recommendation for the health care system of UK to reduce the incidence of CHD in UK.

To get an understanding about different management strategies and models or frameworks implemented in UK for the management of CHD in UK, six academic articles have been chosen for analysis. The summary of the six articles has been presented in this section. The first article by Bhatnagar et al. (2015) gives an insight about the prevalence rate of coronary heart disease in UK. The article mainly provides up to date statistics on mortality, prevalence and cost associated with CVD in UK. The prevalence of coronary heart disease is found the highest in North of England and Scotland. The articles also cover regional variations in mortality, prevalence and inpatient episodes related to CVD. The second article by Bernard, Lux and Lohr (2009) mainly covers the theme of different health care delivery models available in UK for the management heart diseases like CHD. The article mainly summarizes about CVD care delivery models starting from prevention work to palliative care and more detailed insight about care for CVD in prevention and primary care setting in UK. This article can be useful in understanding the preventive and primary care practices that helped to identify unknown case of CHD in UK.

Healthcare delivery models for the management of CHD

In relation to government policies for the management of risk factors related to CHD, two articles has been found to cover in details about policies related to heart disease prevention. The third article by Levy and Tedstone (2017, February) covers the theme of UK dietary policies for prevention of heart disease. From the review of this article, the UK government recommendation in relation to energy intake, salt intake, fruits and vegetable consumption, saturated fat consumption and level of oily fish and fiber needed for citizens is covered. The dietary advice has been integrated with Eatwell guide to support people to understand proper diet needed to improve health and cardiovascular health. In addition, the fourth article by Collins et al. (2014) provides detail insight related to implication of salt reduction policies in reducing the prevalence of coronary heart disease in England. The review of this evidence strengthens the idea about the way in which heart disease policy are modeled in UK and policy is analyzes by means of cost effectiveness analysis, uncertainty analysis and sensitivity analysis.

The details related to cost effectiveness of population wide risk factor reduction programme targeting heart disease like CHD in England has been covered by Barton et al. (2011). The generic economic model is the main theoretical framework that determines the way in which specific risk factor reduction programs decreases the trends related to incidence of heart disease.  Smoking has been found to be a major risk factor of coronary heart disease and the sixth article by Allen et al. (2016) focused on evaluating the impact of tobacco control strategies on reducing inequalities related to smoking prevalence and premature mortality due to CHD. The strength of tobacco control policies in reducing one of the major risk factor of CHD is understood from this academic article.

It is necessary to evaluate theories and management practices presented in the article selected for the paper. The first article provides an insight into the 19^th edition of the Cardiovascular Disease Statistics 2014 report. The burden of CVD, CHD and stroke in UK was presented by means of detail on mortality, treatment cost and morbidity. The mortality data suggested that improvement in mortality rate was achieved in 2012 as it became the second leading cause of death compared to being the first leading cause of death previously (Bhatnagar et al. 2015). However, gender based disparities in CVD outcome was seen as the report showed that CVD remained the leading cause for death for women. In addition, regional variations in mortality were also found as higher mortality was found in North England compared to South England.  Hence, the article highlighted the issue of health inequality, however how leadership can play a role in advancing health equity and eliminating health disparities was not covered. 

Government policies for the prevention of CHD

The article by Graci and Ruffin, (2014) emphasized that certain agencies drive leadership and coordination process for eliminating health disparities. Hence, effective public health leadership can be one source to address inequalities related to incidence of CHD. From this perspective, the transformational leadership can address problem related to CHD in UK. This is said informed by the theoretical aspects of transformational leadership. The theory suggests that transformational leaders are inspiring and visionary and they can take the approach to change individuals as well as the social system (Banks et al. 2016). Koh and Nowinski (2010) also suggest that public health leader can translate health equity goals at community level. The presence of transformational leadership trait can help them to address social determinant factors affecting development of CHD and promote health equality in this area.  When gender is the reason for difference in prevalence rate, then leaders involved in the management of CHD should focus on developing gender responsive health programmes (World Health Organization 2015).  Based on this information, it can be said that working to address social determinants of health and health disparities should also be a part of preventive strategy for CVD in UK.

The second article by Bernard, Lux and Lohr (2009) focused on investigating about care for CVD in prevention and primary care setting. In contrast to the first article, the second article reviewed about the health delivery model for CVD. The first article gave idea about gender inequality issues in disease prevalence, whereas the second articles highlighted about limitations in health screening process for CVD. The article gave a comprehensive overview for each type of health delivery model implemented for CVD. However, the limitation found in the article was that it did not provided good evidence to translate diet and exercise intervention into the delivery system of UK. It also showed that general physicians are the excellent sources for risk screening, time constraints issues indicates training of other allied health staffs in the area of CVD risk assessment. According to Ryley and Middleton (2016), empowering allied health professional is necessary as they can become the leader of change and serve to improve screening process in underserved areas.

In UK, health delivery model has mainly adopted medical model, however biopsychosocial model should also become a necessary part of preventive work to maximize inclusiveness in preventive work and empower vulnerable group to improve their health.  This would mean taking actions according to the Marmot Review policy as it proposed developing sustainable places and ensuring healthy standards of living for all. This means the focus should not only be one illness prevention, but also enabling people to take right control over their lives (Goldblatt 2016). Hence, consideration about the limitation of medical model to CHD and the advantage of social model to CHD may help to effectively integrate social model in preventive programs. This action will also in relevance with the Ottawa Charter as creating supportive environment and reorienting health services are important elements of the Ottawa Charter (Gagné and Lapalme 2017). Therefore, efforts like implementing healthy food programs in schools and inculcating values of health lifestyle in children may pave the way for creating supportive environment for people in UK in the near future. In addition, inclusion of counselors or dieticians in school health promotion program or programs for women may help to reorient health services.

Economic analysis of risk factor reduction programme targeting CHD

The third article by Levy and Tedstone (2017) gave an insight about UK dietary policy for the prevention of CVD. The dietary policy mainly focused on controlling intake of sugar and fibre. The UK government recommendation was to take actions regarding the amount of sugar sweetened beverages and sugar intake among children and young people.  It also proposed action to increase total dietary fibre intake as this is strongly associated with lower risk of cardiometabolic abnormalities in people. Hence, it provides useful implications to make changes in dietary guideline for UK population. However, encouraging people to eat as per dietary recommendation is a challenging task for the government. In this situation, food industry stakeholders should also be targeted so that they provided good nutritionals information and control salt and sugar level in food items to improve health of the population (Christoforou et al. 2016).

The article also gave the idea that reduction of salt intake by 1g can prevent 4147, premature deaths and lead to total cost savings for NHS in UK. Hence, this showed implies that  dietary modifications and lifestyle intervention should be intensified in high risk individual as dietary salt and high blood pressure are two important CVD risk factors (Klaus, Hoyer and Middeke 2010). The UK government has collaborated with food manufacturing companies and implemented salt awareness campaign to control salt intake and reduce risk of CHD. This preventive strategy gives the lesson that analysis and engagement of all key stakeholders is necessary to achieve the goals of CHD prevention. As food industry played a major role in changing dietary habit of people, identifying and managing key stakeholder’s action can prove to be a successful strategy towards change (Christoforou 016).

The fourth article by Collins et al. (2014) mainly focused on economical evaluation of salt reduction policies for reducing CHD in England. CHD is the most prevalence type of CVD in UK and high level of dietary salt intake is one factor that increases blood pressure and creates the condition for the diagnosis of CHD (Ettehad et al., 2016). The study used modeling techniques to identify the effect of reducing dietary salt intake on cardiovascular health outcome for English population. The main trigger for such salt reduction intervention was the implementation of health promotion policies like Change4Life and Health Weight, Healthy Lives Strategy for England. These campaigns utilized media and advertising tools to encourage people to make healthy food choices. The review of the study revealed that such media campaigns are effective in changing health related behavior of patient as well as supporting UK food manufacturers and retailers to make changes in food packaging and labeling so that people easily understand nutritional intake in the food they consume. This kind of policies has been found feasible to reduce the major risk factor of CHD in UK. Hence, research article by Collins et al. (2014) mainly depicted the role of modeling technique in evaluating government policies related to changes in food labeling and manufacturing. The study used IMPACT CHT model which was relevant for the study objective. Creation of such simple models that are supported both theoretically and empirically can be effective in understanding preventive work in the area of CHD prevention.

Impact of tobacco control strategies on reducing inequalities related to smoking prevalence and premature mortality due to CHD

Government’s action to implement salt reduction is a necessary management strategy for heart disease because due to changes in lifestyle preference and availability of different packaged food items, adults are consuming more salt than required (Trieu et al. 2015). Hence, when there is comprehensive evidence regarding the effectiveness of reducing dietary intake of health outcome, then UK government can implement multiple interventions like reformulation of food items, food labeling and media campaigns to reduce salt consumption and make people aware about harmful effect of high salt intake on future risk of CHD (Hyseni et al. 2017).  Salt reduction strategy is likely to be effective because this kind of interventions restrict the dietary intake of sodium chloride and act to reduce the risk factor of CHD like high blood pressure. However, rapid success cannot be achieved and it will require patience to get the desired result.

The fifth article utilized the economic modeling approach to assess the cost-effectiveness of risk factor reduction programme targeting CVD in England and Wales.  A generic economic model was created to two scenarios- one consisting of decrease in blood pressure at population and other related to legislative interventions aimed at reducing intakes of salt and trans fats (Barton et al., 2011).  The advantage of the generic model was that it was created in a way to identify cases of CVDs that were prevented or postponed. The model also helped to estimate cost savings to the NHS and gain in life years and quality adjusted life years (QALYs). Individual benefits as well as total accumulated benefits were calculated. The cost analysis was done by the use of Sheffield prevention model. The uniqueness of the Sheffield model is that it is a deterministic causal model that analyzed econometric component and the epidemiological component (Katikireddi,  Hilton and Bond 2016). Use of this modeling technique in the study showed that reducing CVD risk by 1% can prevent 25000 new cases of CVD and prevent 3500 deaths. This meant a cost saving of about £265m. Barton et al. (2011) also emphasized on the extent of cost saving by stating that this would means annual savings of about  £30m for 10 years of the programme.

In case of specific intervention, Barton et al. (2011) showed that when salt intake legislation reduces salt intake by 3g/day, then it would mean a reduction in population systolic blood pressure by 2.5 mm Hg. In case of legislations related to ban of industrial fats, it showed that reduction in energy intake by 0.5% can reduce risk of death by 5%. Hence, the review of this study indicated that when policy intervention acts to even achieve 1% reduction in risk of VD, then it can leads to substantial cost savings for the NHS (Barton et al. 2011). It can be said that the spreadsheet model is the main highlight of this study as it proved that development of a transparent model for cost estimation can help the UK government to track progress in CHD outcomes when interventions are implemented at local levels. Inclusion of this model in preventive programs can assist in making modifications in the right area and understanding the crucial impact of intervention on population health. This would also create the pathway for a responsive regulation that strengthens the effectiveness of health programs aiming to reduce prevalence of CHD in UK. This approach is also an example of creative regulatory strategies that supports government to fulfill key obligations related to public health and improve food industry action towards population health (Magnusson and Reeve 2015).

Theoretical aspects of transformational leadership in public health

The sixth articles provide an insight into management practices that are necessary for prevention of chronic disease. It focused on analyzing the affect of Tobacco control score on smoking prevalence and premature CHD mortality. The policy model was responsible for feasible improvement in tobacco control policy and paved the way for reducing health inequalities in England (Allen et al. 2016 ). Focusing on this area was important because tobacco smoking is regarded as major causal link for diagnosis of CHD. The analysis of other  cohort based study  also proves that smoking highly contributes to CVD deaths. The seriousness of smoking is also understood from the fact it increases the mortality risk by two fold. However, interventions aimed at addressing the dose of smoking were found to reduce the risk of CVD mortality with time (Mons et al. 2015). Hence, preventive work in this area will lead to reduction in risk for oldest age groups too. This intervention is in relevance with the theory of reasoned action as the theory states that person’s health behavior is affected by their attitude towards the behavior and smoking cessation programs focus on changing people’s attitude towards smoking after knowing about its risk for cardiovascular health (Montano and Kasprzyk 2015.)

As the analysis of six articles revealed several shortcomings in the management and prevention of CHD in UK, the UK government is recommended to prioritize the following action in the future. Firstly, to mitigate gender based differences in CVD hospitalization and mortality, they should focus on developing responsive CVD risk factor management program among women. Secondly, in the area of implementing policies in the area of CHD prevention, there is a need to go beyond patients who are diagnosed with disease and focus more on population at risk of developing the disease in the future. Health policies should also aim at evaluating the effectiveness of  program by the use of evidence based models that favor cost analysis as evaluating effectiveness in terms of cost associated with care.

Conclusion: 

The essay provided an insight into the evaluation of management practices for CHD in UK by the analysis of six articles related to prevention of the disease. The six articles covered important areas like prevalence rate, risk reduction policy, dietary policy, health model and salt intake policies. It enlightened issues related to health inequality, lack of vision for program and lack of evidence regarding effectiveness of certain intervention. However, the articles gave important insight into the use of different models and framework to guide preventive programs. Appropriate lessons can be taken from such programs to take constructive step towards reducing the burden of CVD in UK in the future.

Biopsychosocial model vs medical model for preventive work

References:

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