A message from

Dr LEE Jong-Wook

Director-General World Health Organization

IHeart disease and stroke are currently the leading cause of death in all developed countries and in most developing countries. There were approximately 17 million deaths due to cardiovascular disease in 2003 — one-third of all deaths in the world.

It is disturbing to note that at least 75% of deaths from heart disease and stroke now occur in the poorer regions of the world, which also face major threats from communicable diseases. These regions thus suffer under the so-called "double burden" of disease. If preventive action is not taken urgently, heart disease and stroke — which are already major public health problems — will rapidly advance across regions and social classes to reach epidemic proportions worldwide.

We know that the major risk factors for heart disease and stroke are high blood pressure, high blood cholesterol, tobacco use, physical inactivity, unhealthy diet and obesity. Many of these risk factors result from unhealthy lifestyles. These unhealthy lifestyle habits, which are linked to urbanization, often start in childhood and youth, encouraged by the influence of mass advertising and social pressures. This underscores the importance of targeting children and young people in all programmes that aim to prevent heart disease and stroke.

Prevention and control of heart disease and stroke in developing countries represent a challenging task. There are a number of major barriers to progress, including lack of reliable epidemiological information, inaccessibility of health care, shortages of trained manpower and resources, and misconceptions about heart disease and stroke among policy-makers and the public.

However, the good news is that knowledge about the causes of heart disease and stroke is growing, and various countries are gaining experience in translating this knowledge into effective action.

I believe that our efforts to control heart disease and stroke can only succeed if they are focused at country level. Current WHO activities in this area are based on the WHO Global Strategy for the Prevention and Control of Noncommunicable Disease, which was adopted by the World Health Assembly in 2000. Our goals are to:

• provide guidance to countries on policy, legislative and financial measures that can help prevent cardiovascular disease;

• assess and track the magnitude of the cardiovascular disease epidemic and its social, economic, behavioural and political determinants in developing countries;

• reduce cardiovascular risk factors and their determinants and promote cardiovascular health for all age groups;

• strengthen the health care of people with cardiovascular disease by developing norms and guidelines for cost-effective interventions.

To achieve these goals, WHO has developed standardized approaches to strengthen national surveillance systems for key risk factors. Further, WHO has initiated programmes at country level to scale up health care for those with established cardiovascular disease and to introduce affordable and innovative approaches for managing cardiovascular risk factors and cardiovascular disease in low-resource settings.

WHO is also in the process of addressing some of the main risk factors for cardiovascular disease through global action, such as the Framework Convention on Tobacco Control and the Global Strategy on Diet, Physical Activity and Health. These strategies will help countries in their efforts to develop and implement policies to reduce the burden of cardiovascular disease.

We recognize that advocacy, resource mobilization, capacity development, and research are necessary to galvanize global action against the causes of cardiovascular disease. WHO is working with other UN agencies, research institutions, nongovernmental organizations, the private sector and civil society to promote these activities. Together, we can move the global public health agenda forward to avert unnecessary deaths and suffering due to this eminently preventable disease.

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