Simon Capewell is a Professor of Clinical Epidemiology at the University and is also Vice President for Policy at the UK Faculty of Public Health. Recently he gave the Geoffrey Rose Lecture on Population Sciences at the European Society of Cardiology Conference in Barcelona. The subject of his lecture was ‘Can we eradicate premature cardiovascular deaths?’
“Firstly, it was a great honour to have given the lecture named after a figure a regards as one of the heroes of Epidemiology and Public Health.
In tackling cardiovascular disease (CVD), ‘upstream’ policy interventions such as regulation and taxation are far more powerful than the ‘downstream’ approaches of giving advice or statins to individual patients.
Poor diet, one of the four major CVD risk factors, is more important than tobacco, alcohol and physical inactivity and that population-wide prevention policies involving regulation or taxation are powerful, rapid, equitable and cost-saving.
Vested interests
Yet within the effectiveness hierarchy visible in CVD prevention of upstream policy interventions versus the downstream approaches, he believes it is critically important to firstly gain public support, and then address the politic issues.
A key aspect of this includes overcoming opposition from vested interests.
It is reassuring to remember the many previous public health successes – safe drinking water, sanitation, slavery abolition, and smoke-free cafes and cinemas – generally follow a predictable exemplify pathway, commencing with the initial scientific evidence working through eventually to effective interventions.
Old challenges
The current public health challenges such as sugary drinks, junk food, tobacco, alcohol, poverty and climate change should just be considered new versions of old challenges which we have triumphed over.
This has included an IMPACT Model programme helping to explain the dramatic falls in CVD mortality rates in the UK, USA and other high income countries; and conversely, rapidly increasing CVD mortality rates in China, the Middle East and other low and middle income countries. Here population-wide risk factor trends and policies appear consistently more powerful than modern treatments.
While the cardiovascular disease burden is immense it is preventable with a combination of these policies.”