Challenges Ahead

Implementation of the Affordable Care Act is raising challenges this year and for years to come, but that is a topic being extensively examined elsewhere. Among other challenges medical researchers and the health, most notably, cardiovascular community, have recognized are two which I have chosen to focus on here: (1) the limits of public investment in health research and (2) the call to action of the Global Cardiovascular Task Force.

 

In his November 13, 2013 Journal of the American Medical Association article “Viewpoint”, Dr. Harvey V. Fineberg reported that the federal government’s funding for medical research was no higher in current dollars in 2013 than a decade earlier. Adjusted for inflation, there has been a serious decline in federal funding, over 20% according to Dr. John G. Harold et al. (Journal of the American College of Cardiology, Nov 5, 2013) in his President’s Page. Dr. Fineberg notes that NIH-approved grants have declined from 10,393 in 2003 to 8,765 in 2011. In 2003, 30% of applicants received support; by 2011, less than 19% did. Despite increased industry research spending, the total in U.S. health research declined by 3% between 2010 and 2011. Both articles warn that without adequate research funding, the development of new medical treatments and public health measures will be impeded, reducing our abilities to reduce illness and disability and to extend life. They call upon the medical profession to press lawmakers to increase financial support for health research. Dr. Fineberg recommends Congressional passage of a five-year health research authorization bill, increasing the amount authorized each year, to provide stability and growth in the field.

 

Meeting at the United Nations in New York in September 2011, the world’s Heads of State agreed to “take action against noncommunicable diseases (NCDs) which include cancer, chronic respiratory disease, cardiovascular disease (CVD), and diabetes mellitus. Recognizing that the rising human and financial cost of NCDs required a profound shift in the ways that countries view development,” the UN member states developed and approved the United Nations Political Declaration on the Prevention and Control of NCDs, recognizing NCDs as a development issue and pledging to take action to reduce the human toll of NCDs by 25% by 2025. Last September, the World Heart Federation (WHF), the American Heart Association (AHA), the American College of Cardiology Foundation (ACCF), the European Heart Network (EHN), the European Society of Cardiology (ESC), and representatives from other countries joined together to plan and coordinate their efforts and to facilitate the development and implementation of national plans issuing the WHF/AHA/ACCF/EHN/ESC Presidential Advisory (2013), quoted above.

 

The Advisory stated their goal of a global 25% reduction in premature mortality from cardiovascular disease by 2025 based on the reduction and control of established risk factors: reductions of 10% in the harmful alcohol use and physical inactivity, 30% in excessive salt intake and the prevalence of tobacco use, and 25% in the prevalence of elevated blood pressure. The rises in diabetes and obesity are to be halted. As a first step, the WHF and other participants plan to establish normalized measures of these risk factors by the close of 2014 to assess future progress.

 

The Advisory illustrates the essential link between health research and practice. Its program begins by noting major modifiable cardiovascular risk factors that researchers identified after decades of investigation. Then it plans to establish measures of the prevalence of these factors in national and world populations—a set of projects to be undertaken this year in order to provide baselines with which to assess the effectiveness of interventions to be implemented over the next decade. In short, if this nation is truly committed to joining with others to improve NCD including cardiovascular health, it must recommit itself to funding health research. In fact, such recommitment is essential to any plan to improve any type of health outcomes. As Dr. Fineberg stated “investment in health research…directly contributes to the alleviation of disease, distress, and pain and offers the best hope for long and healthy life for the current generation and for generations to come.”