Author + information
- ∗Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- †Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- ↵∗Reprint requests and correspondence:
Dr. Mark D. Huffman, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1400, Chicago, Illinois 60611.
The World Health Organization (WHO) and its member states have agreed to a shared goal of reducing the risk of premature (age <70 years) mortality from noncommunicable, chronic diseases, including cardiovascular diseases, by 25% by 2025. This “25 × 25” goal is supported by the World Heart Federation (WHF) and includes quantitative targets for risk factors (tobacco, raised blood pressure, obesity, high salt intake, and unhealthy use of alcohol) and health systems (treatment of high-risk individuals with drugs and counseling and availability of essential drugs and technologies) (1,2). If current trends were to continue to 2025, then the risk of premature mortality from noncommunicable diseases would decrease by only about 10%—hence, the importance of the aggressive 25% goal (3).
Training to Achieve “25 × 25”
An ample menu of policy options is offered for member states and international partners to help achieve the “25 × 25” goal. The WHO’s Global Action Plan for the Prevention and Control of Non-Communicable Diseases 2013–2020 recommends, “strengthen(ing) international cooperation for resource mobilization, capacity-building, health workforce training” (1). Existing training efforts within the international cardiovascular research community have largely emphasized skill development in epidemiology and prevention research, given the state of the science and the global shortage of investigators with these critical skills (4). We believe that these training activities, which have been ongoing for more than 4 decades, should be complemented with new training activities that emphasize implementation science, health systems, and health policy research. Also, a new WHF initiative for such training, with the goal of building capacity to implement strategies and policies for global cardiovascular disease prevention and control, is described in the following text.
Global Gaps Despite Shared Risk Factors and Interventions
Data from the INTERHEART (5) and INTERSTROKE (6) case-control studies, as well as the Global Burden of Disease Study (7), demonstrate that ≤10 common modifiable factors account for the majority of risk associated with acute myocardial infarction, stroke, and cardiovascular morbidity and mortality across a wide range of countries. The practice of healthy behaviors throughout one’s life, including avoidance of tobacco and maintenance of healthy diet, regular physical activity, and desirable body weight, leads to a lower incidence of cardiovascular risk factors, better cardiovascular health, fewer clinical events, and better health-related quality of life even among those who have survived a major cardiovascular event. Drug therapy for treatment of raised blood pressure and cholesterol has been shown consistently to reduce cardiovascular events in both primary and secondary prevention settings.
These strategies for improving cardiovascular health are supported by a robust body of evidence established over the past 50 years; yet, their uptake remains far from optimal, particularly in low- and middle-income countries (8). Strengthened health system arrangements and effective implementation of such health policies as universal health coverage and the Framework Convention for Tobacco Control are important strategies for improving population-level health. Yet, to date, these strategies have not been adopted widely enough nor implemented at sufficient scale to realize their full potential impact.
WHF’s Emerging Leaders Program
In response to these persistent gaps in translating research evidence into personal and clinical practices and more effective health systems and policies globally, the WHF has established the Emerging Leaders Program to provide high-level training in implementation science, health systems research, and health policy research (9). Over the next decade, this program will train at least 5 cohorts of approximately 25 individuals/cohort—ultimately, leading to >125 participants selected to represent at least 50 countries. These individuals will have demonstrated long-term promise previously by their early career success, creativity, and passion for improving cardiovascular health and preventing cardiovascular disease. As a consequence of their participation in the Emerging Leaders Program, they will have the capacity to effect change over the remainder of their careers, well beyond 2025.
The Emerging Leaders Program utilizes adult learning theory to encourage “learning by doing” across 3 core components: 1) 10 web-based learning modules with interactive learning objectives; 2) a 5-day, face-to-face think tank seminar for creation of 3 inter-related research proposals, each addressing a common “25 × 25” theme—1 each in implementation science, health systems research, and health policy research; and 3) pilot funding for promising proposals to initiate global and regional research collaboration among the Emerging Leaders.
Feedback from the initial cohort of Emerging Leaders, who participated in the first seminar hosted by one of us (S.Y.) at McMaster University in Hamilton, Ontario, Canada, in 2014, confirms our assessment that this format was highly effective: it led to the initiation of 3 linked, global collaborative pilot projects to increase access and use of essential medicines for secondary prevention of cardiovascular diseases. In March 2015, Dr. J. Jaime Miranda at Universidad Peruana Cayetano Heredia in Lima, Peru, will host the 2015 cohort’s think tank seminar, focusing on raised blood pressure. Between the 2014 and 2015 cohorts, the WHF has already selected 52 Emerging Leaders from 21 countries through a competitive selection process. Future cohorts also will focus on tobacco control, which is a third focal area shared by the WHO and the WHF.
WHF’s Emerging Leaders Program aims to increase capacity for implementation science, health systems research, and health policy research to achieve the ambitious, global “25 × 25” goal, specifically in cardiovascular health promotion and disease prevention. The research collaboration of the first cohort of trainees is progressing as planned, the second cohort’s training is well under way, and we are enthusiastic about the future development of the program.
The World Heart Federation’s Emerging Leaders program has been supported by an unrestricted educational grant from AstraZeneca and is currently supported by unrestricted educational grants from Boehringer Ingelheim and Bupa Foundation. The authors serve as senior program advisor (Dr. Huffman), senior program consultant (Dr. Labarthe), and inaugural steering committee co-chair (Dr. Yusuf) for the Emerging Leaders program, and current president of the World Heart Federation (Dr. Yusuf).
- American College of Cardiology Foundation
- World Health Organization
- World Heart Federation home page. Available at: http://www.world-heart-federation.org. Accessed June 24, 2014.
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- ↵YouTube. World Heart Federation Emerging Leaders Program. Available at: https://www.youtube.com/watch?v=uRB29Ja4-do&feature=youtu.be. Accessed June 24, 2014.