Abstract
One might hope that 12 June 2007, the day the European Heart Health Charter was launched in the European Parliament at Brussels, will be one to remember in the annals of European medical and public health achievements. This unique event was the culmination of years of hard work toward creating a general political and professional acceptance of a European Heart Health Plan, of which the Charter is the crowning symbol. The Charter, reproduced in full from page 357 of this Journal, describes the action that needs to be taken at the European, national and local levels to prevent cardiovascular disease (CVD). The European Heart Health Project, which is funded by the European Commission (EC), will build professional and political alliances between national cardiac societies, heart foundations and other professional organizations, which are necessary to promote the Charter. The many influential signatories to the Charter are morally committed to supporting the Charter, and even more importantly, to making it a reality.
Partnerships in an historical journey
At the turn of the millennium, the European Heart Network (EHN), in collaboration with the European Society of Cardiology (ESC), held a Winning Heart Conference on 14 February 2000 in Brussels, which led to the St Valentines Declaration: ‘Every child born in the new millennium has the right to live until the age of at least 65 years without suffering from avoidable cardiovascular disease'. This visionary declaration required political support; hence the ESC took up the initiative to create a Heart Health plan for Europe based on the common mission of the European Union (EU) member states to reduce the burden of CVD. The first step was to create a simple message to catch the interest and support of the political establishment. In 2002, the leadership of the ESC gained unique access; they worked through the Spanish Society of Cardiology to the Spanish Presidency of the EU and asked for permission to approach the EC with this strategy. The Council of Ministers agreed and this led to the Cork Conference, the EU Council Conclusions on CVD and the implementation of these recommendations in the Luxembourg Declaration. The Charter is a product of a continuous and close collaboration between the ESC and the EHN, professional and public organizations, respectively. These organizations were joined by the WHO Region Europe, which is working in a similar direction. This collaboration underlines the importance of coordinating preventive efforts that had previously been fragmented between various organizations, which had viewed CVD prevention as falling within their private domains. Coordination between all the stakeholders at the European and national levels is mandatory for future success. The need for transprofessional, political and administrative networking is heavily emphasized in the Charter. Although one organization might need to take national leadership to get things rolling it will never be successful on its own. Moreover, collaboration across traditional borders is not only needed, but can also be stimulating and highly enriching.
Steps towards the launch of the Charter
Following the initial support of the Spanish Presidency of the EU, the next step, taken in June 2004 under the Irish EU Presidency, was to collect all available information on CVD prevention, from childhood onwards, to meet the needs of those already afflicted by the disease. A conference was organized at Cork, attended by representatives from all the EU countries. The dimension of the problem, ideas on how to accomplish improved CV health and ways in which plans could be put into action were presented to and discussed by the participating politicians. The proposed action plan was approved in a set of European Council Conclusions that, for the first time ever, acknowledged the need for action, to improve the CV health of European citizens [1, 2]. The next step was to address the issue of implementation. A conference on the implementation of the Cork Council Conclusions was organized by the Luxembourg EU Presidency in June 2005; once more, there was full professional and political representation from the member and accession EU states. Steps to be taken were mutually agreed upon, and were later presented as the Luxembourg Declaration [3]. This opened the door for detailed work on the European Heart Health plan, which was completed in 2006 and funded by the Commission from 2007 onwards. The accompanying European Heart Health Charter was simultaneously finalized, and was launched on June 12 this year. The aim of the Charter is to substantially reduce the burden of CVD in the European Union and the WHO European Region, and to reduce the inequities and inequalities in disease burden within and between countries.
A European phone number towards health
The Charter expresses the goals that need to be accomplished at the population level, to improve CVD health across Europe. This is expressed in simple terms; the targets to be reached are no (zero) smoking, physical activity equivalent to at least 3 km of daily walking, five portions of fruit and vegetables a day, blood pressure < 140/90 mmHg, total cholesterol <5.0 mmol/l, low-density lipoprotein-cholesterol <3.0 mmol/l and no diabetes. This action can be represented as a European telephone number for cardiovascular health: 0-3-5-140-90-5-3-0. Moreover, the Charter underlines the importance of healthy eating habits, normal weight and shape and stable and supportive living and working conditions. The Charter places the strongest emphasis on the message that these given targets should primarily be reached by lifestyle interventions; nevertheless, it advocates the proper use of medication in those with established CVD, or in those at high risk of developing it.
Political collaboration and member state autonomy
The European Heart Health Charter provides the targets to be reached and elaborates on the action needed to achieve these goals. EU member states are, however, free to decide on how they prefer to reach these goals, after taking into account their own priorities, and healthcare organization and risk-factor patterns in their populations. A strong recommendation is that work should be initiated and led by a national organization, for example, by the Cardiac Society or Heart Foundation, reflecting the close continuing ESC and EHN liaison. Alliances then need to be established with other patients’ organizations, primary care physicians, national and local authorities and government departments and agencies, among others. Support for these national networks can be gained by distributing pamphlets and holding meetings; such propaganda can be produced and planned within the European alliance already created by the ESC and EHN. It is important to understand that CV health at a national level cannot be fully accomplished without European political collaboration. Policy decisions at the EU level certainly influence public health at the national level. In future, CV health must be a part of all European policies, not least in the agricultural sector. Marketing, taxation and pricing of food and tobacco have to be agreed upon across borders. Promotion of physical activity at schools, and fostering healthy eating habits among children are other examples in which professional and political collaboration can be the key to success. These and similar issues need attention from political bodies at the EU level, as well as within the individual member states. Research is another important issue. We need to know more about the techniques to convince people about the value of lifestyle interventions and to accomplish these changes. Research in this sector has tended to be fragmented; it has, perhaps, not always addressed the most important issues. Within the framework of the Charter, it is hoped this situation will improve and that resources will be allocated to this important field.
The future of the Charter
The hope and expectation behind the Charter is that it will make people observant, informed and active. The media, politicians, policy makers, professionals and lay people need to understand that it really is possible to improve CV health across Europe. The Charter can then become a reality. The ESC and EHN have worked closely and successfully together, thereby ensuring support from the EC and the WHO Region for Europe. Politicians are willing to listen; however, they are not professionals who have spent a lifetime studying CVD and its prevention. They need to be addressed in a correct and unified way. The European Heart Health Charter, which is clearly written, contains an uncontroversial message and has been signed by all the important organizations in the field of CVD prevention. It is a strong document. It outlines the urgent needs to be addressed and provides a strategy for this purpose. The launch of the Charter on 12 June 2007 will, nevertheless, not be remembered in the annals of European medical and public health achievements, if it does not immediately result in hard and devoted work by those who are unified in the belief that health is precious and worthy of protection.
The great scientist Louis Pasteur said ‘When meditating over a disease, I never think of finding a remedy for it, but instead a means of preventing it': this is a statement of great relevance in the context of CVD prevention. He also said ‘It is only hard work that amuses…'; so, let those of us who stood behind the Charter, signed it and subscribed to it, and all the others involved in the preservation of health in Europe make sure that we do not miss the chance to be amused!