Johanna Ralston


Guest blog from Dr Prakash Raj Regmi MD, President, Nepal Heart Foundation, World Heart Federation member organization

Nepal, a low-income South Asian country, is facing a double burden of disease. While the country is still tackling infectious disease, the prevalence of non-communicable diseases (NCDs), in particular cardiovascular disease (CVD), is increasing at a rapid rate. According to the Nepal Heart Foundation (NHF), 20% of the Nepalese suffer from heart disease. However public awareness about heart health is very low, therefore the Nepal Heart Foundation is dedicated to promoting the prevention and control of CVD in Nepal.

World Heart Day has been observed in Nepal for the past 12 years in order to raise public awareness of cardiovascular disease and encourage policy makers to launch CVD prevention programmes. This campaign increased in scale with the formation of the Nepal Heart Net in 2005, a network of 22 heart-related governmental and non-governmental organizations under the leadership of NHF. World Heart Day in Nepal now involves participants from various sectors, such as political party leaders, high-level government authorities, journalists, celebrities, medical and lay people. Under the leadership of NHF, international service clubs such as Rotary and Lions actively participated in this year’s celebrations. The President of Nepal, Dr Ram Baran Yadav, also participated in World Heart Day.

World Heart Day 2012 was celebrated in more than 50 districts over seven days, from 22 to 29 September. This covered two-thirds of the Nepalese population. Each of the 22 Nepal Heart Net organizations had their own separate World Heart Day activities and on 29 September, the Nepal Heart Net organized a joint event including a rally around the city with live music.
In line with the 2012 focus on CVD prevention among women and children, the National Go Red for Women campaign in Nepal was also linked to World Heart Day. The heart-healthy message successfully reached policymakers as the Nepal Government acknowledged the importance of CVD prevention in women and children and announced they would launch an integrated national NCD programme at the earliest.

More about NHF activities, such as the new CVD prevention campaign known as “Go green for children” and the “Sea to Everest Summit” public awareness campaign, will be available in the fortchcoming December issue of Heart Beat (World Heart Federation newsletter).

Visit the Nepal Heart Foundation website.


This year World Heart Day takes on a special meaning. Falling a year after the United Nations (UN) High-level Meeting on Non-communicable Diseases (NCDs), cardiovascular disease (CVD) and other NCDs have been placed in the global spotlight for the first time ever. As the leading cause of death worldwide and a major burden on the global economy, it has been timely for these diseases to be raised in front of not only health ministers but also the entire UN General Assembly. And yet, political attention does not guarantee improved health outcomes or reduced rates of death from heart disease and stroke. In order to have maximum impact, advocacy and political efforts must be supported by public awareness campaigns that promote heart healthy living. This is where World Heart Day (WHD) plays a crucial role. Every year on 29 September we celebrate World Heart Day and encourage all people worldwide to take care of their hearts and be mindful of their cardiovascular health. The overarching WHD theme for 2011 and 2012 has been “One World, One Home, One Heart” reflecting the importance of elevating CVD on the global health agenda while also highlighting each individual’s responsibility to introduce heart-healthy behaviours into their families and homes.

Within this theme, in 2012 we are focusing specifically on CVD prevention among women and children. Women and men are equally affected by heart disease and stroke, however the CVD risk among women is seriously underestimated. Cardiovascular disease is actually the leading cause of death among women and is responsible for a third of all female deaths worldwide. Building on efforts of the Go Red for Women campaign, a goal of this year’s WHD campaign is to increase global awareness of the true CVD risk that women face and to encourage them to take care of their own and their family’s heart health.

Children are also vulnerable to CVD as the risk for cardiovascular disease can begin early in life. As enumerated by our Urbanization and cardiovascular disease report, childhood exposure to tobacco use, physical inactivity, poor nutrition and obesity increases the chances that they will develop cardiovascular disease later in life. This has recently been reinforced by a study released this week in the British Medical Journal that suggests children who with high body mass indexes face a 30-40% greater risk of developing CVD than children of normal weights.

Join us this weekend in raising awareness of the impact of CVD and actions each individual can take to reduce their own and their family’s risk of developing heart disease or stroke. Participate in one of the many World Heart Day activities planned across the world or spread the World Heart Day message virtually by being active online through news outlets and social media. Remember we only have One World, One Home, One Heart.



World Heart Day

Urbanization and cardiovascular disease report

View our infographic on CVD risk among women and children

BMJ article on CVD risk in children

Join the conversation on Twitter using the hashtag #WorldHeartDay

Stay connected with World Heart Day on Facebook 


By 2030 the World Health Organization (WHO) predicts that nearly 23.6 million people will die from cardiovascular diseases (CVD). This is a staggering number and a significant jump from the current 17.3 million CVD  deaths per year, a number which represents 30 per cent of ALL global  deaths. But we are familiar with these numbers. It is the reason for our  engagement in global advocacy activities to put cardiovascular disease and  other non-communicable diseases (NCDs) on the global development agenda and to have them recognized as a priority for sustainable development. The landmark United Nations (UN) High-level Meeting on NCDs was a first  step towards achieving this recognition and in May of 2012, we applauded  the WHO for the passage of a global mortality target to reduce NCD deaths 25 per cent by 2025.

As we approach the one year anniversary of the UN Summit on NCDs, an event  that takes place only days before World Heart Day, the World Heart  Federation will be preparing to launch its “25 by 2025″ campaign – a  campaign to unite all those players interested in halting and reversing  the global CVD burden.

The campaign is of course in light of the WHO 25 by 2025 global mortality  target. However, we are calling on our partners and supporters to help us  achieve a 25 per cent reduction in global cardiovascular disease deaths.

How can we do this? Our supporters have long been a part of our activities to raise awareness through our World Heart Day and Go Red for Women campaigns and through the World Congress of Cardiology.

Now we call on  members and CVD partners across the globe to help us achieve this ambitious goal by aligning our efforts and strengthening our partnerships.

We will work together with media, stakeholders and the private sector to  ensure that the 25 x 25 CVD target is achieved.  This will require strong  NCD policies at the country level (a concrete commitment within the UN  Political Declaration); costed and achievable CVD goals within those  policies; commitment to redoubling efforts around reducing mortality  through simultaneously addressing global leadership, risk factors and  treatment; and strengthening media awareness of CVD in key countries.

All of this will be coordinated with an overall effort to improve policies and  accelerate advocacy while working in partnership with the private sector  to share best practices and create solutions that place business interests  in alignment with good health.

We recognize and affirm that reducing cardiovascular disease is not just about addressing an individual’s lifestyle ­ it is about bringing all  players to the table to work towards a common goal and set of objectives.

Together, we can halt the rising burden of cardiovascular disease. Reduce premature CVD mortality by 25 per cent by 2025? Yes we can!

To find out more about our advocacy goals, visit our website >


Today marks the beginning of World Breastfeeding Week, which focuses on raising awareness worldwide, of the health benefits associated with breastfeeding to both infants and mothers. Although it is cited by the World Health Organization (WHO) as the best form of nutrition for newborns and infants, mothers around the world face barriers to breastfeeding that prevent or hinder their ability to breastfeed for the recommended amount of time. In addition to providing support to new mothers, increasing public awareness about the benefits of breastfeeding may help break down some of those barriers. Not only does breastfeeding help prevent malnutrition and support proper development of the infant’s brain and immune system, but infants who are breastfed tend to have lower cholesterol and blood pressure levels as well as lower rates of overweight and obesity as adults, all of which improve cardiovascular health.

The impact that proper nutrition during foetal development and childhood has on the risk of developing cardiovascular disease (CVD) later in life is not widely recognized.  Prompted by this, the World Heart Federation has dedicated World Heart Day 2012  to raising awareness of the CVD risk among women and children.  As described in the World Heart Federation’s report, Urbanization and cardiovascular disease: Raising heart-healthy children in today’s cities, the relationship between foetal and childhood development and later CVD risk is multifaceted.  Both undernutrition and overnutrition early in life can increase risk for developing CVD.  Evidence suggests that individuals who are undernourished while in utero and at childbirth bear a higher CVD risk later in life. Meanwhile, maternal obesity during pregnancy has been associated with obesity in children, which also increases the risk of developing CVD later in life.

Join us this week in celebrating World Breastfeeding Week, and continue to show your support for the health of mothers and children worldwide by running a World Heart Day campaign on 29 September.

Let us know what you have planned for World Breastfeeding Week and World Heart Day by leaving your comments in the space provided below.


Guest blog from Cristina Parsons Perez, Director of Cancer Advocacy 

Taskforce on Non-Communicable diseases (NCDs) and Women’s Health

The Taskforce on Non-communicable diseases (NCDs) and Women’s Health organized a Satellite Session on 22 July in Washington DC, during the 2012 International AIDS Conference, entitled “Women, HIV and NCDs: making the links and moving to action”.

The taskforce’s first joint activity brought together leading panelists to explore the links between NCDs and HIV; the burden of NCDs on women living with HIV and highlight current on-the-ground experiences in integrating services.

The panel made mention of the increased risk for cardiovascular disease among HIV-positive individuals and the high rates of hypertension and obesity observed. Discussions on integration of services emphasized access to universal healthcare; working with private healthcare providers; exploring packages of NCD prevention and treatment services at HIV testing and screening sites as well as treatment centres. Panelists highlighted the existence of low-cost interventions for tackling NCDs but also underlined the need for increased funding for NCDs. Peter Piot, Director of the London School of Hygiene & Tropical Medicine and former Executive Director of UNAIDS noted the issue of co-morbidities and the need for careful public health burden assessment  to avoid siloed budgeting and horizontal health programmes. The taskforce launched a policy brief on Women, HIV and NCDs that will be available soon through the taskforce website

Can you share any examples of countries that have successfully integrated NCD prevention and treatment programmes within their  HIV screening/testing services?

Download the infographic which demonstrates why we must invest in women’s health  >






Guest blog from our member organization, the African Heart Network

By Mrs Bola Ojo, Executive Secretary, African Heart Network


March 8th is International Women’s Day — an opportunity to celebrate the achievements of women and also to remind the world about the challenges that heart disease and stroke pose not only to women and global health but also to sustainable development worldwide.  African Heart Network (AHN) is committed to working in partnership to reduce the cardiovascular disease (CVD) burden in Africa and the inequalities that come along with it.

Misperceived as a “man’s disease”, CVD has too long been neglected in the women’s health arena.  In actuality, it causes 8.6 million deaths in women, each year, making it their number one killer. In response to this, World Heart Federation members around the globe, including seven in Africa, have started the Go Red for Women campaign, originally conceived by the American Heart Association, to raise awareness about the specific vulnerabilities women face with regard to CVD. AHN has joined in this fight to raise awareness of CVD risk and draw attention to the fact that many deaths in women are in fact preventable. Poor nutrition with inadequate intake of fruit and vegetables as well as the consumption of diets high in trans or saturated fats, physical inactivity and tobacco use all increase the risk of developing CVD.  The good news is that these risk factors are modifiable.

Given the limited financial resources of many countries in Africa, health education is  a key strategy for preventing the increasing trend of CVDs.  A massive health campaign transmitted through local radio in multiple languages can help inform populations on a large scale about improving diets by reducing the intake of sodium, sugar and trans and saturated fats. This would reach both rural and urban poor communities.  And it must be accompanied by campaigns to call for better access to health foods, including product reformulation.

While communicable and preventable diseases including malaria, HIV/AIDS and tuberculosis are still prevalent, CVD and non-communicable diseases (NCDs) within Africa are on the rise and are expected to be on par with communicable diseases in the next few years. Globalization and urbanization in Africa is resulting in increased exposure to risk factors as people move out of villages and into cities, a traditional diet rich in fruit and vegetables is gradually being replaced by one rich in calories from animal fats and low in complex carbohydrates. This dietary change is combined with a decrease in physical activity as people move away from traditional farming into sedentary jobs.

More than a health concern, research indicates that CVDs and other NCDs contribute to household poverty. This leads to health inequalities in all countries and poses a major impediment to achievement of the Millennium Development Goals (MDGs).  Women should be at the centre of the CVD discussion, not only because of their personal risk of dying from CVD but also due to their role within families and communities. Differences in the status of women and men lead to disparate opportunities to the claim of human rights, including the right to health. The status of women also places them at greater risk of being exposed to certain CVD risk factors. Furthermore, their traditional role as caretaker of the family could allow women to become empowered as effective champions of heart-healthy behaviours for the entire household.

As we celebrate, International Women’s Day 2012, let’s unite in our call for concrete action around  women’s health issues to be taken. Together, in partnership, let us rally governments, civil society and communities to take responsibility and address the “call of our hearts!” Tell us what you are doing to celebrate International Women’s Day via twitter:



Love cities?  This Valentine’s week, in my first-ever video blog, I explain why the World Heart Federation is calling for urgent action to protect children’s heart health in the world’s most populous cities. Click on the picture below to watch the video:

To find out more, download the report >


Johanna Ralston, CEO, World Heart Federation


When Member States met during September’s United Nations High Level Summit on Non-Comunicable Diseases (NCDs), one of the clear outcomes in the Political Declaration was their agreement to develop global targets to reduce the burden of NCDs by the end of 2012. Last week, the World Health Organization (WHO) Executive Board met here in Geneva and the commitments to targets and timeframes appeared in danger, as calls for more time and more targets threatened to undermine what Member States have committed to in the Political Declaration and further delay implementation with new deadlines for the creation of targets proposed for 2013 instead of 2012.  Fortunately, leadership by key actors involved in negotiations and   powerful statements by the NCD Alliance, other civil society organizations, and certain member countries, ensured that we will see those targets “completed” this year. Notably, Member States have agreed to “submit a substantive progress report on the development of a framework, including a set of indicators and targets, to the sixty-fifth World Health Assembly (May 2012) for consideration,” with “completion” committed to by the end of the year.

As the saying goes, “what gets measured gets done” and the discussions at the WHO Executive Board have brought us one step closer to being able to monitor and track progress made on NCDs.  However, it is clear that controversy concerning how many and which targets will be presented at the World Health Assembly has not yet been resolved.  The complexities include lack of a complete picture of available data and underlying surveillance systems that would be key in setting baseline measures against which to achieve targets.  As well as limited and uncertain resources at a time when the major global organizations, including WHO and the Global Fund, are undergoing severe resource constraints and reform processes; and only an emerging recognition that achieving the commitments laid out in the Political Declaration and being debated in the targets process will require a different framework for policy, funding and partnership, what has been called a “new policy narrative.”

For the NCD and health community, this is the time to come together and build solidarity around which targets are needed to successfully reduce the global burden of cardiovascular disease and other NCDs.  It is imperative that work on the global monitoring framework for NCDs is completed by the end of 2012, as agreed upon by member states at the WHO Executive Board last week.  However, all of us will need to work together to ensure that the timeline laid out by last week’s resolution on NCDs is actually fulfilled.

The most critical goal  included within the WHO proposed set of targets is one that has been championed by the NCD Alliance, that is to decrease the overall mortality from NCDs by 25% by the year 2025, using the mortality in 2010 as a baseline (and recognizing possible advantages in extending that goal to 2030 to align with development goals).  In order to do this, all the major risk factors of NCDs must be addressed – including physical inactivity, which is noticeably missing from the current set of targets proposed by the WHO.  There has been a push from many within the NGO community for the creation of a target for the reduction of physical inactivity, however some Member States feel that it does not sufficiently satisfy the WHO requirements regarding what should constitute a global target.  A sticking point is an accurate indicator for physical activity.  In other words, what measurement could governments use that would allow them to effectively monitor and track changes in physical activity levels?  PAHO and GAPA have suggested legitimate and defensible indicators, as have many of our colleagues who submitted comments to the NCD Alliance prior to the Executive Board meeting, including the segmentation of targets based on age.  The need for consistent data presents a legitimate challenge, yet to allow the targets process to continue without addressing physical activity seems a far greater problem.

Please weigh in:  should physical activity be addressed in the global targets?

For more information

See the list of proposed WHO targets listed as table 2 in the following discussion paper

Download the statement made by the NCD Alliance at the Executive Board

Download the complete text of the WHO Executive Board Resolution on NCDs

Access full documentation from the 130th Session of the WHO Executive Board

Johanna Ralston, CEO, World Heart Federation

Johanna Ralston, CEO, World Heart Federation


While we have been talking a great deal in recent months about the intersection of health and foreign policy, through the planning for the UN meeting and the ways in which our members have been targeting not just ministers of health but also ministers of foreign affairs in their advocacy, the discussions around cardiovascular disease and non-communicable diseases (NCDs) and trade have been less apparent.  Yet trade can play a critical role and the World Heart Federation, through its role with the NCD Alliance, recently had the opportunity to participate in a high level meeting on the topic, at the World Trade Organization in Geneva.

Panel at the 5th High Level Symposium on Global Health Diplomacy

Panel at the 5th High Level Symposium on Global Health Diplomacy

The 5th High Level Symposium on Global Health Diplomacy, organized by the  Graduate Institute of Geneva at the WTO, assembled  leaders from some of the top health and trade agencies in the world including the  Directors General of the WTO, WHO and WIPO and the Executive Directors of UNAIDS, the Global Fund, and GAVI, among others.  While the different panels highlighted some of the challenges faced at the intersection of health, trade and foreign policy, I was invited to bring to the conversations the issues related to NCDs and trade, with a particular focus on prevention and NCDs, including tobacco control, food policy and essential medicines.  At the end of the session, our panel was summed up perfectly– it is time that the dichotomy between infectious and non-communicable diseases is toppled.  For both, the prevention agenda is the trade agenda.

Sustainability will be at the core of our ability to deal long term with NCDs and to continue to address communicable diseases. Reports estimate that 9 billion people will populate the world in 2050. We have now surpassed 7 billion and that 7th billion person is more likely to die of an NCD than anything else. When we look at some of the key factors affecting health, one of the most significant is our built environment –or lack thereof – which is inherently political. Globalization and urbanization have brought with them many opportunities.  Yet they have  also facilitated access to many of the risk factors leading to NCDs  – increased exposure to tobacco, unhealthy foods and alcohol – while also limiting access to many things needed for our health and wellbeing – safe spaces for activity, quality and affordable medicines, and access to health care workers.   All in some way or another related to trade and foreign policy.

One point that was referenced only briefly is that of food – an area in which all of  the above mentioned organizations will have a significant role to play. As we have seen the shift from rural to urban, we have witnessed more individuals surviving infectious disease related illness and more people with access to food. And yet, there are some startling facts out there. There are nearly 925 million people living with hunger and over 1.5 billion people obese. The conventional thinking is that these are separate issues, with undernutrition characteristic of  low income countries and overnutrition a problem of high income countries . Yet, those most at most at risk are the poorest populations WITHIN each country, regardless of the country’s  GDP, and often affecting the same populations – ie, undernutrition is increasingly recognized as another risk factor for overnutrition because of conditions associated with the former that are still poorly understood. Both over and under nutrition are battles being lost by the most vulnerable socio-economic groups in the world.

Within some of the most prosperous countries, such as the US, well over 10 percent of the population lives in poverty. As we make strides in addressing hunger, we seem to be creating a crisis of nutrition – studies show that prenatal exposure to under- nutrition leads to both impaired glucose levels and coronary heart disease later in life. While for those populations facing over-nutrition, the same is true.  Conditions associated with increased urbanization also contribute to nutritional challenges – there may be more calories available in urban settings, but these are often not proportionally nutritious. Access to health – whether it be safe and affordable drugs, nutritious food, or health care workers – is the most glaringly difficult for the poorest populations. So what is the connection? Are there connections?

I say yes. Good health – sustainable health – depends on nutrition, which depends on agriculture; and agriculture is changing significantly.  As climate change on the one hand and increasingly large agribusiness on the other change the food supply chain,  the link between  food source and consumer is more tenuous . Between farm and fork, there are many players – particularly if you live in urban centers. As we focus on producing as much food as possible, we are missing the crucial element of nutrition – which is getting lost in production lines. Is providing food – even if substandard – enough?

When I think about the players that came together to discuss trade, I can’t help but feel that the same issues will be raised in a decade, but not about medicines – about food.  Lack of access, lack of partnerships, a dire need for leadership and sustainable solutions are needed now to ensure that we prevent future dilemmas in addressing health disparities.  What are measures we can take now to ensure that addressing food insecurity and a sustainable food supply also take into account the quality of nutrients and taste, so that successes in reducing undernutrition are not eclipsed by challenges of overnutrition later on?

To read more about the link between urbanization and cardiovascular disease, look for our upcoming report (link to executive summary).



Johanna Ralston, CEO, World Heart Federation

Johanna Ralston, CEO, World Heart Federation


With the introduction on 1 October of a “fat tax” in Denmark – a surcharge on foods with more than 2.3 per cent saturated fats – we asked our member organizations to give their reaction to this new law.

I am delighted to introduce this first guest blog, written jointly by the Danish Society of Cardiology and the Danish Heart Foundation, and congratulate their efforts on a national level to reduce the burden of cardiovascular disease (CVD).

Dr Inge Vestbo, MD, Managing Director, Danish Heart Foundation

Dr Christian Hassager, President, Danish Society of Cardiology

Obesity and overweight continues to increase in Western Europe as a result of unhealthy diets and low physical activity. Healthy diets are characterized by a high intake of fruit, vegetables, legumes, fibre, whole grains, nuts, vegetable oils, and fish; whereas unhealthy diets are characterized by a high intake of salt, red meat, processed meat, saturated fat, trans fat, refined grains, and refined sugars. Unhealthy diets greatly increase CVD incidence and premature mortality. Key problems are high salt intake, sugar sweetened beverages and saturated fat, each accounting for 10–15% of calories consumed by youth. Campaigns and public education programmes have not yet succeeded in changing these unhealthy lifestyles.

Changing dietary patterns from unhealthy to healthy will substantially lower cardiovascular risk. The causal linkage between consumption of saturated fat and risk of CVD is beyond discussion; the question is how to reduce consumption of saturated fat in the general population as well as those at increased cardiovascular risk. For those at increased cardiovascular risk, individual measures are needed but it is well recognized that small changes in risk of disease in the whole population can lead to greater reductions in disease burden than large shifts among those persons already at risk. Taxation is a widely used measure to regulate population behaviour: its efficiency has been shown in tobacco consumption, where fiscal measures are the most efficient in preventing smoking uptake in adolescents and reduce smoking in the less affluent. Although tobacco does not compare directly to food, taxation of unhealthy food content has the potential to modify food habits in a healthier direction. For this reason The Danish Society of Cardiology and the Danish Heart Foundation welcome this new tax on saturated fat.

Taxation of unhealthy food has been estimated to have the potential to reduce CVD deaths in the UK by 2%. Taxation of salty foods and sugar, including soda taxes, are already implemented in some countries. No substantial knowledge of the effect on consumption or obesity exists but tax is often lowered due to lobbying from industries. It is well recognized that the current “default” dietary patterns are pushed in the unhealthy direction by a number of conditions, including the ease of access to junk food, healthy choices being more expensive, marketing by the food industry and EU agricultural policy. Opponents to taxation of unhealthy food allege that taxation and other legislation will lead to a “Nanny state” that hinders the free choice of people but the fact is that free choice remains for the individual. Taxation of saturated fat just helps make the healthier choice the easier choice.

Inequality in health is increasing. Cardiovascular risk factors tend to accumulate in the disadvantaged. Whereas fiscal measures are more efficient in changing behaviour among the disadvantaged, the burden of the tax is also unequal. This is a paradox that has not been sufficiently addressed.

For now the Danish tax is mainly of symbolic value – it will result in relatively small increases in the price of meat, more in fatty meat, less in lean. It may have some impact on consumption of dairy products high in fat content, which the Danes still use a lot of when preparing traditional food. It will not hit whole milk, as only products with more than 2.3 per cent fat will be taxed. However, Danes use only 5 per cent of their income on food so the effect on their dietary habits and thus consumption of saturated fat is likely to be minimal. For taxation to have a real impact and translate into measurably reduced CVD and saved lives, the taxation has to be heavier. However, a principle has been established with wide political support and this is an important step in the right direction

Dr Inge Vestbo MD                                            &                         Dr Christian Hassager
Managing Director, Danish Heart Foundation                  President, Danish Society of Cardiology


Should the global CVD community push for taxation of unhealthy food as a key source of revenue for addressing NCDs within health systems?
Should we emphasize taxes on unhealthy foods as a means of changing personal behaviour around dietary choices, alongside our continued efforts to prioritize increased budget allocations for NCD prevention and control?

© 2013 World Heart Federation Suffusion theme by Sayontan Sinha