Conquering Heart Disease And Stroke: An Ounce of Prevention Is Not Enough.
GA Mensah
Cardiovascular Health Program, Centers for Disease Control and Prevention

The Singapore Declaration of 1998 called on government agencies and health-related organizations worldwide to forge the will for long-term heart health and develop effective programs that will curtail the global epidemic of heart disease and stroke. Implicit in this declaration was the notion that the appropriate "preventive dose" or necessary capacity for effective elimination of cardiovascular disease (CVD) was a combination of both infrastructure and the will to take action. The Victoria Declaration of 1992 and the Catalonia Declaration of 1996, had already established that we have the scientific knowledge to succeed in this endeavor, that multiple worldwide examples of successful investments in heart health exist, and that adequate resources and techniques exist to overcome the barriers faced in efforts identify disease burden, plan, implement and evaluate CVD prevention programs. Establishment of CDC's State-based CVH program in 1998 was a step in the right direction. However, current level of funding is inadequate for effective environmental supports, policy change, comprehensive interventions for CVD prevention, program evaluation, or widespread dissemination of best practices in preventive services. Interventions and practices known to be effective are currently not being implemented. To deliver the appropriate "preventive dose", the program must first be expanded to cover all states and territories and enhanced to permit implementation of the full spectrum of comprehensive health promotion and disease prevention strategies. Research translation, improved surveillance, informatics support, partnerships and coalitions, social marketing techniques, and continuing program evaluation must play crucial roles.