The Singapore Declaration

Forging the Will for Heart Health
in the Next Millennium

Declaration of the Advisory Board of the
Third International Heart Health Conference
Singapore, September 2, 1998

Foreword

On the occasion of the Third International Heart Health Conference, the Advisory Board issues forth The Singapore Declaration: Forging the Will for Heart Health in the Next Millennium. The Declaration calls for urgent action to reduce the global burden of heart disease, given new evidence that cardiovascular disease has overtaken other diseases in developing countries and is now the world's leading cause of death. The greatest tragedy of this epidemic is that it is largely preventable.

The Declaration's purpose is to make the case for action so compelling that all concerned will be motivated to act, based on their heightened awareness of the scope of the epidemic and the strengthened conviction that we can control it.

The Advisory Board calls upon all governments as well as all individuals and organizations concerned with heart health to recognize this: the need is great, the remedial strategies are known - now we must all FORGE THE WILL to act in this common cause for heart health.

The Singapore Declaration is the third in a series. The first, The Victoria Declaration on Heart Health, was issued on May 28, 1992 and the second, The Catalonia Declaration issued on June 1, 1995. All Declarations are authored by the individuals who comprise the Advisory Board to the International Heart Health Conferences, not by their respective organizations.

John W. Farquhar, M.D.
Chair, Advisory Board
Third International Heart Health Conference

Thomas A. Pearson, M.D.
Vice-Chair, Advisory Board
Third International Heart Health Conference

Declaration

Recognizing that cardiovascular disease has reached epidemic proportions and has rapidly expanded in severity and breadth to become the leading cause of death, disability and rising health care costs throughout the world, and that it would be largely preventable through a public health approach to cardiovascular disease, given the resources and the will to act, the Advisory Board of the International Conference on Heart Health calls upon:

_ health, media, education and social science professionals, and their associations

_ the scientific research community

_ government agencies, especially those concerned with health, education, trade, finance, culture and recreation, commerce, and agriculture

_ the private sector

_ international organizations and agencies concerned with health and economic development

_ community health coalitions

_ voluntary health organizations

_ employers and their organizations

to marshal the will to eliminate this modern epidemic over the long-term, and to join forces to develop the cohesive policy-making, economic, scientific, technical and physical infrastructure necessary to accomplish that goal.

Conclusions

The key message for clinicians, researchers, and all others who wish to advance the cause of cardiovascular disease prevention is that they must accept personal responsibility to take a leadership role. This leadership often requires new knowledge and a new set of skills, including skills in social marketing, in advocacy, and in building partnerships and coalitions.

Chapter 5.

Conclusions

The Singapore Declaration has dealt with creating capacity for improvement in heart health. This, in turn, requires international, national, and community infrastructures to implement heart health programs, and the will to act. The one quality common to the discussion of infrastructure and will is leadership. Thus, The Singapore Declaration calls on individuals, as well as local, national, and international health service organizations in the public and private sectors, to recognize the expanding epidemic of cardiovascular disease and to step forward as leaders in promoting heart health. Without such leadership, neither an infrastructure nor the will to use it will be possible, and without this capacity, the cardiovascular epidemic will continue unabated.

Chapter 6.

Recommendations

It is recommended that:

1. The international community recognize the need for global policies to counter a cardiovascular epidemic of truly global proportions and causes.

2. International, national, and local organizations that deal with health place cardiovascular disease high on their agendas.

3. Countries and communities more developed in their heart health capacity share their policy-making, intellectual and scientific, physical and organizational, and economic capacities with countries and communities that are developing their heart health program.

4. Countries and communities developing heart health programs use comprehensive approaches, which should endeavor to include interventions in several settings on all or most of the major risk factors, using several channels, to effect population-wide change.

5. Those concerned with heart health take decisive action to accept responsibility and leadership, outside their traditional professional focus as scientists, clinicians, and experts.

Leadership and Policy-Making

It is recommended that:

6. International, national, regional, and local organizations show leadership in promoting heart health to prevent expansion of the epidemic, given the global growth in morbidity and mortality from cardiovascular disease.

7. International, national, and local organizations raise public awareness and action on government policies that benefit or adversely affect heart health.

8. Community leaders organize whatever "social capital" is available around the issue of heart health.

9. International and national agencies collaborate in the establishment of a Global Heart Health Observatory as a world-wide resource for effective policies and programs to document and promote "best practices" in heart health. This heart health network database could include morbidity and risk factor survey instruments and protocols, model policies and laws, intervention methods, etc., which might be used widely by countries developing heart health programs.

Expanding the Knowledge Base

It is recommended that:

10. International and national agencies identify the magnitude of the cardiovascular disease epidemic and the burden of cardiovascular disease on the population.

11. Ministries of Health and international agencies with an interest in health and social development, within the context of the technical and financial resources available, conduct surveys on morbidity and mortality, and also estimate risk factor prevalence, the use of medical services, the identification of high risk target groups, and the social costs of the disease.

12. Ministries of Health and international agencies with an interest in health and social development carry out studies of the burden of CVD to project the long-term impact of the cardiovascular disease epidemic into the 21st century.

13. In formulating cardiovascular disease health policies, policy-makers seek the advice from clinicians and scientists in the traditional medical and laboratory disciplines as well as from experts in public health, behavioural sciences, health education, law, economics, and political and social sciences.

Infrastructure and Organizational

It is recommended that:

14. Governments and health agencies develop intersectoral policies targeted at the population at large to address the determinants of cardiovascular health

15. Governments, professional societies, and health care systems join to develop policies for the identification of persons at high risk of cardiovascular disease and for their cost effective treatment.

16. Health agencies organize heart health-related programs which integrate action on tobacco, hypertension, diabetes, nutrition, physical activity, and obesity.

17. Health care systems integrate and evaluate behavioral, pharmacological, and technological approaches to cardiovascular disease treatment.

Financial and Economic

It is recommended that:

18. Governments, non-governmental organizations, and international health and social development agencies increase their economic investment in cardiovascular disease prevention and control to reflect the increasing burden due to this disease.

19. Non-governmental organizations commit increasing amounts of funds to support research in dissemination and implementation of programs and policies for heart health.

20. National and international health agencies concerned with heart health establish partnerships with the private sector to assist with the implementation of surveillance, public education programs, and provision of heart healthy products to consumers.

Forging the Political Will

It is recommended that:

21. The media itself be informed and responsible for disseminating accurate information about heart health, given their influence on daily habits of people and the world. Legislation, regulations, or incentives may be required to ensure that this responsibility is carried out.

22. Heart health organizations develop effective health communications aimed at the major risk behaviours and risk factors.

23. Organizations involved in heart health develop educational and media programs identifying cardiovascular disease as a major health problem to influence governments to recognize the cardiovascular epidemic and to realign resources and infrastructure to make heart health a priority.

24. All concerned with heart health at international, national, and local levels accept responsibility and assume leadership to act now at the policy-making, scientific, organization-building, and economic levels to develop heart health programs to curtail this global epidemic in the 21st century.

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