Governments should enforce strategies and reforms, taxation and incentive structures, to address the growing burden of cardiovascular disease.

To address the growing burden of cardiovascular disease (CVD) and the leading risk factors of high blood pressure (BP), high blood sugar and obesity that contribute to millions of deaths, governments need to enforce strategies and reforms, taxation and incentive structures, that encourage healthier lifestyles. Policy reform is essential to ensuring people have equitable access to healthy food options and opportunities for exercise, putting heart-healthy choices within reach of all. As the guardians of population health, governments have an essential role to play in taking measures that encourage healthy eating, physical activity, and limit tobacco use and alcohol abuse. Enforcing such policies can have a much greater effect on population health than strengthening the health system alone, as interventions on the underlying determinants of health reach a much broader segment of the population and require less effort.

Key interventions and indicators
  • Implement policies with proven effect on population health and on CVD. Examples include the introduction of tobacco or sugar taxes, the total ban on salt and trans fat in processed food, or policies reducing the harmful use of alcohol. Cities engaging with urban planners to enhance possibilities for physical exercise have also seen significant successes.

    Tobacco and alcohol
    • Raise taxes on tobacco products and alcoholic beverages
    • Ban tobacco/restrict alcohol advertising, promotion and sponsorship
    • Establish smoke-/alcohol-free environments in public areas and workplaces
    • Engage different sectors, such as food producers and processors, consumers, and others to reduce intake of salt/sodium, saturated fatty acids and trans fats, added sugars, etc.
    • Ban the marketing and sale of foods with high levels of salt/sodium, saturated fats, trans fatty acids or free sugars in settings where children gather (nurseries, schools, pediatric clinics, etc.)
    • Promote healthy food in all public institutions and in the workplace
    Physical activity
    • Develop transport policies with relevant sectors to improve the accessibility and safety of, and supportive infrastructure for, walking and cycling
    • Adopt and implement national guidelines on physical activity for health
    • Improve provision of physical activity in educational settings (from infant years to tertiary level)
  • Use new revenues from sin taxes to increase budgets for primary healthcare and establish integrated programs for treating hypertension, diabetes, dyslipidemia and other risk factors
  • Enact task-shifting policies to empower non-physician health workers to manage hypertension and cardiovascular diseases, through screening, referral for diagnosis and management, patient education for lifestyle improvement, follow-up and reminders for medication adherence and appointments
  • Introduce data- and performance-based outcome measurements so primary care providers are held contractually responsible for the results they achieve in the population
  • Include cardiovascular indicators in national health information systems to enable the use of reliable and timely data at all levels of the health system and to maximize the impact of interventions  
  • Introduce mandatory hypertension screening for all adults over 18 years of age in all primary health centers to accelerate early detection
  • Develop a national digital health strategy that includes a digitized health information system, with interoperable standards and processes across all levels of the health system

The indicators below can come from a variety of sources (primary and secondary data collection, national or regional surveys and databases).


  • # and type of new (proven) health policies established

    Tobacco and alcohol
    • Tobacco use (adolescents and adults)
    • Regulation and standards around taxation of tobacco related products
  • Alcohol
    • Level of alcohol consumption (adolescents and adults)
    • Prevalence of heavy episodic drinking among adolescents and adults
    • Alcohol-related morbidity and mortality among adolescents and adults
  • Food
    • Regulation and standards on the level of salt/sodium/sugar/trans-fat/saturated fat intake
    • # of people reached via awareness campaigns about importance of reducing excessive salt intake
    • % of salt content in processed food
  • Physical activity
    • Level of physical activity (adolescents and adults)
  • Increase in primary care funding to improve quality of care for CVD patients
  • Policy change in task-shifting to enable nurses, mid-wives, community health workers and non-traditional health workers to conduct BP screening and follow-up visits for hypertension patients

Recommendations described herein were developed by the Novartis Foundation and/or its partners as part of the Better Hearts Better Cities and other initiatives; before local implementation, interested parties must ensure compliance with all applicable laws and regulations, including local industry codes and institutional policies. Links and content may be subject to change without notification.

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