Cardiovascular diseases represent around one third (30%) of the expected mortality causes during 2005, which amount to 35 million deaths. This is according to a report issued lately by the World Health Organization titled (Prevention of Non-communicable diseases -Vital Investment) .What complicates things, is that treatment of cardiovascular diseases has become a very pressing burden on the health system, being very costly and its treatments are sometimes ineffective.
Hence, prevention and control of such diseases are necessary to match the developments of curative services. In addition, this preventive management is the best means for confronting the burden of such diseases, and reducing its high costs.
The Executive Board proactively thought of reviving the Committee of cardiovascular diseases, to undertake the following tasks:
a) Work towards setting a work plan and a joint Gulf Program.
b) Setting the epidemiologic control, surveillance and evaluation system for cardiovascular diseases together with follow up of analysis of these indicators and their results as well as evaluating the progress made and depicting the health policy priorities.
c) Setting national programmes to change the behavioural pattern and life style and education of the people change their life pattern (nutrition, sports, smoking cessation - periodic check up and other factors predisposing to cardiovascular diseases) .
d) Work towards adoption of the concepts of joint care of chronic diseases between health centers and hospitals, strengthening referral system, and adopting new methods for provision of health services such as the specialized mini-clinics in PHC for care of the chronic diseases patients - etc.
Resolution # 3/53 (Gevena, Safar 1423H /May 2002)
It emphasized the following:-
A. Control of Cardiovascular Diseases in member Countries:
1- The establishment of a system to enhance epidemiological screening, with the main function of monitoring and assessing cardiovascular diseases in each of the member countries.
2- Work on adopting the concept of “Chronic Diseases Shared Care” in primary healthcare centers and hospitals, and to strengthen the referral system, and adopt modern approaches in the provision of healthcare services.
B. Health education and counselling of citizens towards proper health behavior and change of traditional life style:
1- Intensify the “Educational Programs” that help to change their living style and to avoid environmental factors and dietary habits that impact their health negatively.
2- Adopt the suggested Gulf plan, to support and develop health education programs, related to cardio-vascular diseases and diabetes, to be sent to “The Arabian Gulf Program”.
C. The establishment of “The Gulf Cardiovascular Society”
The council blesses the formation of the above-mentioned society, to be chaired by H.E. the Minister of Health in Qatar, and the membership of representatives from member countries, without any financial obligation on the “Executive Board”, as this society is a philanthropic and voluntary entity. The establishment of this society should not contradict the activities of the “Gulf Cardiovascular diseases Committee”, which is emanating from the “Executive Committee”, as well as it is a governmental entity. The availability of goals, views, and clear cut work methodologies are very important for each of them.
Resolution # 3/54 Abu-Dhabi, Shawwal 1423 (Jan. 2003)
It affirmed the start of central registration for cardiovascular diseases in Qatar and called on the member states to establish a database for such group of diseases similar to the Gulf cancer registry.
The E.B received a letter from H.E The Minister of Health in Qatar based on the said resolution concerning the proposed Gulf plan for control of such group of diseases, containing 4 points:
1- Assessment of the magnitude of the problem.
2- Establishing permanent committees in the member states, as well as a Joint gulf Committee for prevention of cardiovascular diseases.
3- Application of preventive programs at 3 levels:
a- Primary level – preventive programs to reduce risk factors before the occurrence of the disease.
b- Secondary level – preventive and curative programs after the occurrence of the disease.
c- Tertiary level - for avoiding complications.
4- Provision of financial resources for such programs.
In its 59th meeting (Riyadh 3-6/11/2003) the Executive body issued recommendation # (7) which adopted the general outlines of the comprehensive plan of control of such group of diseases, especially the item dealing with assessment of the magnitude of the problem and hence formulating the priorities of health policies required to deal with such diseases Application of the various preventive programs on the most vulnerable groups was emphasized as well as the adoption of the concept of shared care of chronic disease through PHC.
The regional consultative meeting on prevention and control of hypertension was held in Abu-Dhabi 26-28 Shawwal 1424 (20-22 December 2003) in collaboration with the EMRO.
Extremely important recommendations were issued; the most prominent of which were:
A) Recommendations to the member states:
1- Positioning “Hypertension” on the top of the national agenda of priorities.
2- Formulating the national strategies to face “Hypertension” as part of a comprehensive plan to prevent non-communicable diseases.
3- Encouraging health care systems and part of MOHs to support and promote the following:
- Cost effectiveness studies to prevent and control hypertension in PHC centers.
- Promotion of health education.
- Taking appropriate actions to set physical activity and nutrition as well as smoking cessation as high priority programmes.
4- The great need to change the concept of health services of chronic diseases (non infectious) from the model of “acute cases” to “comprehensive” and shared care” model.
B) Recommendations to the EMRO:
1- Setting “Regional Training Courses” on non-communicable diseases.
2- Preparation of a regional manual (guideline) for (nutrition, obesity, measures of healthy life styles).
3- Preparation of a regional manual (guidelines) for prevention and care of hypertension within specific framework.
Gulf Symposium for Heart Diseases
Manama, Bahrain Sha’ban 1424H (Oct. 2003)
1- The EB in its 59th meeting endorsed most of the recommendations issued by the symposium: The general framework of the comprehensive control plan for these diseases was adopted including assessing the magnitude of the problem thus setting priorities for health policies, and implementing the preventive plan especially on the high risk groups.
2- Affirming the need to adopt the shared care concept for the chornic diseases through the primary health care.
In its 60th meeting, (Safar 1425H / April 2004) the Executive Body issued recommendation No. 5 which involved the following important points:
1- Assigning the Gulf Committee for Cardiovascular Diseases to prepare a unified national Gulf program heading at implementing the Gulf plan according to phased specific stages and a well-defined mechanism of follow up and development of systems of monitoring, surveillance and evaluation, in addition to preventive programs and establishing centers of databases and implementation of central registration.
2- Putting hypertension on the top of priorities of the national health concerns, and designing national strategies to face this disease as part of an integrated plan for control of non-infectious diseases.
3- Encouraging health care systems by supporting studies of national economic feasibility to the costs of control of such group of diseases especially hypertension in the PHC centers.
Important Cornerstones in the development of this program:
Resolution # 2 issued by conference 59 (Geneva, Rabi I, 1426 H/May 2005) which included :
a) Endorsing the guideline of the Gulf Society for Heart on Acute Coronary Syndrome, as a unified Gulf guideline.
b) The necessity to support and promote the role of PHC in the field of control of cardiovascular diseases.
Recommendation #4 was issued by the Executive Body in its 63rd meeting (Riyadh, December 2006) where the specialized Gulf Technical Committee was assigned to assess the current situation, and prepare a comprehensive framework for a Gulf National Program which aims at reducing the rates of morbidity and mortality similar to what happened in a number of the western developed countries , according to well specified priorities.
Recommendation # 4 issued 64th meeting of the Executive Body (Riyadh, 17-19/3/1427H - 15-17/4/2006) which involved assigning the specialized technical committee in its meeting for :
a) Preparing the new organizational structure for the work of committee (setting the vision, mission, objectives and targets) in the light of the new international and regional developments.
b) Developing and updating the Gulf plan for control of cardiovascular diseases after evaluating the current situation in such a way to cope with the future.
c) Setting a Gulf /national work plan aiming at reducing rates of morbidity and mortality due to cardiovascular diseases. The work plan includes, mechanism of work, follow up of surveillance systems, control and prevention programs.
d) Studying the proposed projects on the part of the Gulf and the Saudi Health Society about the unified Gulf Registry about Acute Coronary Syndrome, with defining the method of work and supervisory body.
The technical committee held its first meeting in the new structure in Riyadh at the location of the Executive Board (Muharram 1428 H/February 2007) the outcome of this meeting included the following :
1) The new organizational framework - where the vision, mission and the objectives (13) for the current stage were put.
2) The unified Gulf Registry for Acute Coronary Syndrome - where after detailed and objective discussion, it was agreed on establishing a task face to undertake the mission of producing a unified Gulf model.
3) Cooperation and Coordination with the Gulf Heart Society . The relation was defined, and the committee affirmed the importance of these organizational steps to define mission and responsibilities as well as to avoid duplication and sustain mutual cooperation.
4) Developing and updating the Gulf plan for control of cardiovascular diseases - a task force in cooperation with the Executive Board was assigned this mission guided by the endorsed strategic plans in similar programs.
5) Setting a unified Gulf national work programme aiming at reducing mortality and morbidity due to cardiovascular diseases.
The committee made 10 recommendations which were very specific and focused on:
1) Raising the slogan “Year 2008 - for control of cardiovascular diseases “.
2) Establishing a national committee for control of cardiovascular diseases in all the Council States.
Recommendation # 4 was issued in the 66th meeting of the Executive body (held in Riyadh, Rabi I, 1428 H / July 2007) where it has been emphasized on: :
1. Work towards finalizing development and update of the Gulf plan for control of cardiovascular diseases within 3 months. This is done by a task force in such a way to match with the recent international developments and the current and future Gulf requirements.
2. Assigning the said task force to put the general framework for the unified national / Gulf work program within 6 months.
Resolution # (6-A) was issued by the Health Ministers in their 64th conference, which was held in Riyadh (Muharam 1329 H - February 2008) which is considered the cornerstone for this ambitious program through:
1- Endorsing the new organizational framework of the Gulf Committee for control of cardiovascular diseases (vision, mission, strategic objectives).
2- Endorsing the updated (Gulf plan for control of cardiovascular diseases) set by the specialized Gulf Committee under the theme “Hearth First” to be implemented in the Ministries of Health and other related ministries and institutions.
3- Holding an expanded meeting with participation of the deputy ministers, high leadership or consultants in the field of control of cardiovascular diseases in each member state in the Council, as well as the members of the technical committee to set the “Integrated Executive Gulf Plan (2009-2018) and to transform the Gulf plan into a framework for the unified national / Gulf work program according to time lines which are very specific with clear responsibilities, missions and outcome, within 3 months similar to the endorsed Gulf Plan for Diabetes .
4- The Council states have to provide the Gulf Technical committee with detailed reports about the epidemiology of such group of diseases as well as the studies and research conducted. and the working national plans and programs in this field.
5- Work towards giving effect to the slogan “The Year 2008 - for control of cardiovascular diseases “ through:
a) Implementation of the Gulf plan for control of cardiovascular diseases
b) Giving effect to the items of the “Gulf Charter for health of the heart” in cooperation with related agencies.
c) Support of scientific activities (conferences - symposia - workshops) related to control and prevention of this group of diseases.
d) Support of epidemiologic research on CVD, the associated risk factors, burden of disease and consequent economic impact.
e) Support and promotion of the role of community individuals and the family in improving healthy life styles and reducing risk factors .
6- Establishing a national committee for control of cardiovascular diseases in each of the Council States to include representatives from various health and medical as well as related academic and community sectors, to adopt and implement the endorsed programs, policies and plans.
7- Emphasis on strengthening the constructive cooperation ties with all national , Gulf and regional agencies, societies, and organizations for raising the standard of the Gulf Health and control and prevention of cardiovascular diseases.
The Executive body in its 68th meeting (Riyadh, 21-23/4/1429 H – 27-29/4/2008) issued recommendation # 3 which involved the following:
1. Praising the initiative taken by HE the Yemen Minister of Public Health and Population about actions taken to prevent smoking in public places, with the objective of reduction cardiac attacks.
2. Holding an expanded meeting with participation of deputy ministers and high officials, as well as the Gulf Committee members for Control of Cardiovascular Diseases, in the KSA during the last third of 2008.
3. Work towards holding a Gulf conference on “Economics of Prevention of Cardiovascular Diseases” in the KSA in the last quarter of 2008, in collaboration and coordination with related international organizations. This comes within the series of scientific conferences “prevention of chronic diseases is a vital investment”.
Outcome of the Expanded Meeting of the Gulf Committee for Control of CVD.s
The meeting was held in Riyadh (28-29/1/1429 H – 26-27/11/2008) & is considered a very important turning point in the executive procedures taken as well as the monitoring mechanisms. The committee undertakes the following functions:
a) It sets the integrated executive plan (2009 – 2018)
b) It sets the periodic follow up tables for the national programmes for control of CVD.s
c) Mechanism of update of the Gulf plan for control of CVD.s
The committee, too, issued a number of recommendations notably:
- Urging the Council States for more practical, material, community and media commitment to promote the Gulf program for prevention of CVD.s, and giving more attention and awareness about giving effect to the (Gulf charter for Health of the Heart) and putting it into action in all related governmental, scientific and civil society sectors.
The Arabian Project for Control of CVD.s
from the perspective of the Health Ministers’ Council for cooperation Council States.
Resolution # 6/B for the 64th conference of the Health Ministers’ (Riyadh, 27-28 Muharram – 5-6/2/2008) was issued, which entailed:
- Endorsement of the “Gulf Charter for Health of the Heart… Putting Heart First” under the name of Riyadh Declaration.
- Work towards raising the slogan (2008… the Year for Control of CVD.s).
Recommendation # 3 was issued by the 68th Executive Body Meeting (Riyadh, 21-23/4/1429 H – 27-29/4/2008) which involved:
Raising the Gulf charter to the Arab Health Ministers next meeting, based on the joint work and in appreciation to the letter of HE The Secretary Council of the Arab League in this regard, and in live with what happened in the Diabetes control programme.
HE the Director General of the Executive Board Health Ministers’ Council gave a very important presentation in the Arab Health Ministers Council in Cairo (25-26/4/1429 H – 29-30/6/2008) in the preparatory meeting for the Economic Developmental and Social Arab Summit, under the title:
(The Arabian Project for Control CVD.s… Putting Heart First) where he presented the international changes in the health needs, and compared this with the magnitude of the problem in the Arab World, in addition to alluding to prevalence of risk factors which precipitate heart diseases in the Arab community.
Outcome of the 67th Conference of the Health Ministers
(Geneva, May 2009) where resolution # 3 was issued involving the following:
1- Endorsement of the integrated Executive plan (2009 – 2018) of the Gulf plan for prevention of CVD.s, set by the concerned committee (vision, mission – strategic objectives – mechanisms of implementation – indicators of follow up and improvement)
2- It approved the periodic follow up tables for the national programs for prevention of CVDs set by the technical committee, and putting it into action in the Council States.
3- Giving effect to the previous recommendations and resolutions to implement “the Unified Gulf Registry for Acute Coronary Syndrome”.
4- Emphasis on continuous periodic follow up of the performance indicators, implementation mechanisms to give effect the Executive Gulf plan for control of CVD.s, and assigning a focal point in each country for that purpose.
The Gulf Committee for Control of CVDs
(Riyadh, 18-19 Muharram, 1431 H – 4-5/1/2010) which ended up with issuing a number of recommendations, most prominent of which were:
a. Strengthening and support of the call upon the countries to reduce the prevalence rate by 25% within 10 years (2009 – 2018 | as a strategic objective of the Integrated Gulf Executive plan for Control of CVD.s
b. Work towards increasing national expenditure for cardiac care, through emphasis on the role of PHC in primary and secondary prevention as well as patient rehabilitation.
c. The necessity for commitment of implementation of national plans for control of CVDs to ensure implementation of Al-Manamah Declaration.
d. Inclusion of religious and spiritual principles of education related to health promotion, and keeping the health of the heart and the welfare of spirit within the educational curricula in all health institutes, and medical universities as part of the health education strategy (through coordination and cooperation with related bodies).
The 72nd Executive Body Meeting (Riyadh, 13-14/5/1431 H – 27-28/4/2010) which issued recommendation # 5 involving:
1) Urging the Council States to give effect to the Integrated Gulf Executive Plan (2009 – 2018) and the Gulf Charter for Health of the Heart (Putting Heart First) through measurement indicators in all health facilities including heart centers and departments in the Council States.
2) Work towards support of giving effect to “Al-Manamah Declaration – Economics of Cardiovascular Diseases) as an applicable integrated framework within the general frame of the Gulf plan for Control of CVD.s (2009 – 2018)
3) Emphasis on the necessity to speed up national laws enactment to control tobacco in public places and taking strict actions to protect public health of the community, as one of the basic components of reduction of incidence rates of heart attacks, similar to what has been achieved in the developed countries.
4) Emphasis on the importance of women empowerment in the fields of health of the heart as an integrative way (items 8 of Al-Manamah Declaration)
5) Addressing the Gulf and national societies interested in the cardiovascular diseases to give more attention to include in their annual conferences in the scientific scope items like epidemiology, prevention and control, impact on public health – health system)
The Gulf Conference on Economics of Cardiovascular Diseases – Putting Heart First
All Thanks to Almighty Allah the Lord of the Worlds and peace and blessings on the most Honorable of his Messengers, Mohamed Peace be upon Him, and on all his companions.
Under the generous patronage of His Majesty King Hamad Bin Essa Al-Khalifa , King of the Kingdom of Bahrain , may Allah protect him,the Executive Board of the Health Ministers’ Council for the Cooperation Council States organizes, in collaboration with the Ministry of Health , Kingdom of Bahrain ,the Second Health Economics Conference under the theme : “ Economics of Cardiovascular Diseases .. Heart First “in the period 9-11 Muharram, 1430 H/ 5-7 January 2009, at Manama, Kingdom of Bahrain.
This conference comes in continuation of the successful efforts of the Executive Board to hold a series of specialized conferences about health economics, which started with Economics of Diabetes Conference, in 2007 in the light of the increasingly given attention by their majesties and highnesses the princes and the leaders of the Cooperation Council States about cardiovascular diseases as well as the support for prevention and control of such diseases in the Gulf Community.
This conference comes to give effect to resolution # 6 –A issued by the 64th conference held in Riyadh (27-28 Muharram, 1429 H/ 5-6 February 2008). Their Excellencies the Ministers of Health fully agreed that year 2008 is the year of control of cardiovascular diseases where the Gulf Charter of Health of the Heart has been issued and signed by their excellencies the Ministers of Health, H.E. the Secretary General of the Cooperation Council for the Arab Gulf Countries as well as the Director General of the Executive Board of the Health Ministers’ Council for the Cooperation Council States.
The importance of this conference comes in the light of the evidence-based information and statistics in the WHO report entitled “Prevention of Chronic Diseases is Vital Investment” which showed that cardiovascular diseases represent nearly 30% of the expected causes of mortality in all ages in the world in 2005, i.e. more than 17.5 million deaths and more than 80% of cases which occur prematurely are preventable. Cardiovascular diseases represent 10% of the expected causes of the global burden of diseases in all ages in the world.
On the other hand, the main risk of factors of noncommunicable diseases are collectively considered to be a principal cause which is responsible for 80% of mortalities due to cardiovascular diseases and stroke. Every Year, more than:-
- 4.9 million person die because of tobacco use.
- 1.9 million person die because of physical inactivity
- 2.7 million person die due to decreased consumption of vegetables and fruits
- 2.6 million person die because of overweight and obesity.
- 7.1 million person die because of hypertension.
- 4.4 million person die because of hypercholesterolemia
Many regional studies on a population sample aged 25-65 years, affirmed the wide spread of risk factors in the Gulf region as follows:
Overweight & Obesity 40-70%
Decreased Activity 80-90%
Based on this, it is worthy to mention that organizing this conference, which is considered the first of its type in the Eastern Mediterranean Region, comes due to the worthy attention and concern on the part of the Ministries of Health in the Cooperation Council States. The conference involves the participation of an elite group of international, regional and local scientists and experts in this field and it highlights the burden of this group of diseases imposed on the health systems and governments as well as the challenges faced in this respect. The conference will focus on the related economics in the various aspects, and examines the new initiatives in health promotion and how to provide cost effective care.
Reduction of premature deaths of the people in the community due to cardiovascular diseases.
Undertaking a leading role to confront cardiovascular diseases and hence controlling the main cause of disability and premature deaths, and consequently reducing burden of diseases, economically, socially and humanise.
Scopes of the Conference
1. International, regional and Gulf challenges and response to these challenges.
2. Costs of optimal care of cardiac patients
3. Simulation modules of economics of cardiovascular diseases
4. Building “Gulf, regional and international alliance for health of the heart, to reduce the burden of cardiovascular diseases
5. Prevention of cardiovascular diseases and the comprehensive and sustained intervention programmes with entry to healthy life cycle.
6. Assessment of current situation of health of the heart in the Gulf region.
7. Policies and work plans of the Health Ministers’ Council, GCC for prevention of cardiovascular diseases.
8. Methods of giving effect to “the Gulf Charter for Health of the Heart “Heart first”
9. General platforms for research on effectiveness of policies and preventive interventions (characteristics of expenditure on health care)
10.Strengthening the role of the civil society in prevention of cardiovascular diseases and reduction of its incidence.
In addition, two workshops will be held
a- Basic principles on economics of heart diseases
b- Workshop for women about (Empowerment of women to play an effective role in preventive and curative management of cardiovascular diseases and the related risk factors)
Aims of the Conference:
1. Highlighting the economics of cardiovascular diseases in its medical and social dimensions: internationally, regionally, and at the Gulf.
2. Presentation of the great challenges imposed by the cardiovascular diseases on the health systems, health care costs (whether direct or indirect) and how to confront these challenges as well as presenting some of the leading modules.
3. Enabling people and patients and development of social marketing to widely spread health cducation especially that directed to youth, women and elderly people.
4. Involving stakeholders and giving more effect to their role in prevention of cardiovascular diseases.
5. Increasing the knowledge of concerned and interested officials about the economic aspect of cardiovascular diseases and about the outstanding International initiatives and experiences & to control such diseases.
6. Presentation and study of the means for development of the quality of services provided to cardiac patients and the optimal use of available resources.
7. Promotion of adoption of recent guidelines for prevention of cardiovascular diseases endorsed by the related international organizations.
8. Coming up with recommendations directed to decision - and policy- makers to deal with the problem in a systematic and practical approach.
1- Executive Board, Health Ministers’ Council for Cooperation Council States.
2- World Health Organization, HQ, Geneva.
3- WHO Eastern Mediterranean Regional Office.
4- World Heart Federation
5- Europe Heart cardiology Society.
6- Saudi Heart Association.
7- Changing Our World.
8- Imperial college, London, UK
9- Sydney University, Australia.
10- Columbia University, USA
11- Royal Hospital in Glasgow, Scotland.
As a result of this conference, Al-Manamah declaration on “Economics of Cardiovascular Diseases” was approved by all participants.
In the same line, The Health Ministers’ Council for Cooperation Council States in its 67th conference (Geneva, 25/5/1430 H – 20/5/2009) issued resolution # 3 which decided to:
1. Express thanks and gratitude to HM Hamad Bin Essa Al-Khalifah – King of Bahrain Kingdom for his kind patronage and hosting the conference which had its great impact regionally and internationally.
2. Express thanks to HM Shikha Sabeka Bint Ibrahim Alkhalifah – wife of HM King of Bahrain for sponsoring and participation in the women; symposium held alongside the conference activities under the title (Empowerment of women to undertake an effective role in control CVDs)
3. Express thanks to HE Dr. Faisal Bin Yageb Al-Hamar minister of Health, Bahrain and the participating health leaders, the members of scientific and organizing committees for the strenuous and continuous efforts exerted and which contributed in the very unique shape of the conference, regionally and internationally.
4. The Council praises high the efforts exerted by Dr. Tawfik Khoja – Director General of the Executive Board, Health Ministers’ Council, Chairman of the conference in organization and holding of such important Gulf conference, with the very positive outcome and constructive recommendations.
5. Agree on the (Al-Manamah Declaration on Economics of CVDs) and its endorsement for action in the Council States.
6. Assigning the Gulf Committee for control of CVD’s to transform Al-Manamah Declaration to an integrated work platform, to be implemented, and monitored within the concept of updating the Gulf plan for prevention of CVDs within 6 months and to match the recent world trends.
GULF CHARTER FOR THE HEALTH
OF THE HEART
Evidence -based statistics in the WHO report: “Prevention of Chronic Diseases - Vital Investment) showed that cardiovascular diseases represent about 30% of the most important expected causes of death in all age groups in the world in 2005, i.e more than 17.5 million deaths - and more than 80% of case that took place prematurely can be prevented.... Also they represent 10% of the expected cases of world burden of diseases (DALY).
On the other hand, the NCD risk factors are considered a main cause of mortality and burden of diseases in all countries regardless of the economic development state in these countries collectively. The main risk factors are considered responsible for 80% of deaths to cardiovascular diseases and stroke.
It is worthy to mention that the Executive Board proactively thought of introducing a Gulf Committee for Control of Cardiovascular Diseases, realizing that this group of diseases pose an increasingly great burden on the health system in the Council States, and cause a great deal of suffering and economic burden on the costs of health care.
The Gulf programme has remarkably achieved a lot in its march ending in a number of ministerial resolutions and Executive body as well as the technical committee recommendations.
Due to the steady growth of the problems (health, social and economic) which outmatched the current developments, the Health Ministers’ Council for Cooperation Council States revisited the whole issue in a very comprehensive way to combat and prevent cardiovascular diseases.
Thus, the specialized technical committee was restructured (February 2007) which made note worthy recommendations, on top of which was raising the slogan (2008 - a year for control of cardiovascular diseases) .
In the same line, the Executive Board had fully reviewed the whole situation and in particular the “Gulf Programme for Control of Non-communicable Diseases) and other related Gulf Programmes such as (EMAN- Diabetes - Heart Diseases - Cancer) to define the areas of commonality in general and to focus on joint efforts towards one aim , in addition to methods of effecting the world strategy of diet, health and physical activity, and to match the world recent trends on the epidemiologic map.
In compliance with the WHO / eleventh programme of work 2006/2015 which stresses on improving determinants of health through promotion of healthy life styles and prevention of such diseases. Also, a lot of effective interventions as well as successful international experiences which enabled some countries to reduced premature mortality due to non infectious diseases (in general) and cardiovascular diseases ( in particular). It became very evident that solutions may become highly effective even in areas which suffer shortage of resources.
It turned out that any slighter modification in the average level of risk factors in the population, might lead to great and sustained reduction in the burden of diseases and mortality due to heart diseases in Australia, Canada, United Kingdom and USA.
Importance of Community Interventions
Community programmes for prevention and control of chronic diseases are targeting a specific community and focus on alleviation of the effect of risk factors and community partnership.
Integrated community programmes aim at reaching lay people, and high risk groups of high priority in schools , workplaces, recreational places, religious places, healthcare provision facilities. These programmes also urge the communities to participate effectively in making decions related to health. They also work towards encouraging utilization of the community resources and health services, in addition to coordination between various activities through partnerships and alliances.
Successful community interventions require establishing partnerships between community organizations, policy makers, facilities and health care providers as well as population. These interventions concerned with chronic diseases in the developed countries revealed high effectiveness and return in the developing countries as well.
Based on this, the Executive Board drafted the project “Gulf Charter for Health of the Heart”. similar to the European charter, which had been launched mid My 2007, and following the same approach 0f the Diabetes Control Programme.
The subject had been discussed in detail in the 67th meeting of the Executive Body (held in Riyadh, 8-10/11/1428 H/ 18-20 /11/2007) which issued the recommendation (11-B) which was raised to the Ministers of Health in their 64th meeting held in Riyadh (27-28 /1/1429 H/ 5-6/22008) and resolution # (6-B) was issued which involved:
1) Thanking Dr. Tawfik A M Khoja – Director General of the Executive Board for his presentation entitled (GCC Heart Charter: Putting Heart First) and considering it a scientific and practical approach for preparing the Gulf charter for health of the heart.
2) Approval on and endorsement of the “GCC Heart Charter: Putting Hearth First» as Riyadh Declaration.
3) Work towards raising the slogan (Year 2008- for control of cardiovascular diseases) and putting it into action.
4) Assigning the specialized technical committee to set a unified Gulf plan which focuses on transforming the Gulf charter for health of the heart into temporal executive plans along ten years with objective of reduction of rates of morbidity and mortality due to cardiovascular diseases.
5) Work towards giving effect of the role of the “Gulf health promotion project for control of cardiovascular diseases” and review of the “Gulf Plan for Health Education) in this respect to strengthen and deepen this concept.
In the Name of Allah, the Most Merciful The Most Beneficent
Economics of Cardiovascular Diseases
It is in Al-Manama City, the capital of the Kingdom of Bahrain on the 25th of Rabi II, 1430 H corresponding to 21st of April 2009, and in the conference of “Economics of Cardiovascular Diseases” which was blessed by the supreme patronage of HM King Hamad Bin Essa Al-Khalifa- King of Bahrain Kingdom, under the supervision and participation of HE the Minister of Health , Kingdom of Bahrain Dr. Faisal Y. Al-Hamar, and of representatives from the Health Ministers’ Council for the Cooperation Council States and the Director General of the Executive Board Dr. Tawfik Bin Ahmed Khoja, as well as the , World Health Organization (Headquarter, Geneva) and the WHO/Eastern Mediterranean Regional Office, World Heart Federation and the European Society of Cardiology, in addition to the Saudi Heart Association. The activities of the conference included a symposium for women under the patronage and the participation of HH Shaikha Sabeeka Bint Ibrahim Bin Mohammad Al-Khalifa the wife of HM the Kingdom of Bahrain under the theme “Empowering women to play an active role in the preventive and curative management of cardiovascular diseases”; the symposium is an integral part of this declaration.
● In remembrance and realization of the following declarations, statements and resolutions :
- Results of the international summit, 2005.
- UN Millennium Declaration.
- Health related Millennium Development Goals, and resolution No. 60/265 on 30th June, 2006.
- Interim report of the Eastern Mediterranean Regional office about the progress made towards achievement of MDGs, August 2008.
- WHO World Health Assembly resolution # WHA 57/17 on 22nd May, 2004 about the Global Strategy on Diet, Physical Activity and Health.
- WHO World Health Assembly resolution # WHA 60/23 on 23rd May, 2007 about prevention and control of non communicable diseases ; implementation of the international strategy (medium-term plan 2008-2013).
- WHO General Secretarial Report (A61/8) on 18th April, 2008, and resolution WHA 61/14 on 24th May, 2008 about implementation of the international strategy for prevention of the non communicable diseases.
- Economic Cooperation and Development Organization report issued in 2008: “Prevention of life style – related to chronic diseases : An Economic Framework”.
- Gulf Charter “Health of the Heart… Heart First” signed by their excellencies the Ministers of Health in the Cooperation Council States and HE the Secretary General, Cooperation Council of the Arab Gulf countries, on Wednesday, 28 Muharram 1429 H corresponding to February Ist. 2008 in Riyadh in the 64th Conference of the Health Ministers’ Council for Cooperation Council States.
● Realizing that support of public health systems and prevision of health care is the basis for achievement of developmental goods agreed upon internationally including the Millennium Development Goals.
● Indicating that cardiovascular diseases are of chronic and serious nature, and can be prevented and controlled to a large extent.
- And in case no proper preventive and curative actions are taken, those diseases will result in severe life-threatening and highly costly complications.
- And this group of diseases impose a large health and economic burden on the families, communities, countries and the entire humanity.
- And they represent a serious threat to achievement of the Developmental Goals agreed upon internationally including the Millennium Development Goals.
● Realizing at the economic level that:
- Cardiovascular diseases are a huge economic burden at all levels affecting individuals, families, communities and countries.
- Cardiovascular diseases in the Cooperation Council States and some other regions take an epidemic form which largely devours the health care budgets.
- If cardiovascular diseases continue to occur in the current prevalence rates, those countries will reach a stage where most national budgets will be directed towards care of such patients and the grave complications of the diseases.
- The indirect cost of this group of diseases which include loss of productive human working force and other costs are higher than the direct costs of treatment and care of such patients.
- Based on the concept that investment in prevention of cardiovascular diseases is an investment in prevention of other non communicable diseases such as diabetes, hyperlipidemia, obesity and cancer in addition to improvement and giving effect to the concept of health promotion with its multi-dimensions and in totality.
The participants decided to adopt Al-Manama Declaration on economics of cardiovascular diseases as the first regional declaration which emphasizes the importance of the economics of this specific group of diseases, and investment in their prevention.
1. Calls for establishing an international reference body (authority or organization) as an administrative unit or the like for economics of cardiovascular diseases to be founded under the umbrella of the United Nations with the countries represented in the General Assembly and with participation of the international organizations including the World Health Organization, Health Ministers’ Council for the Cooperation Council States, World Bank, World Heart Federation, International Health Economics Association and other interested organizations. This body should have regional offices to undertake the following responsibilities :
- Setting a database about the current situation of heart economics and indicators.
- Expecting the future economic burden of cardiovascular disease on the economic and monetary system at the regional and country level.
- Provision of advice and consultation to the member states as related to its efforts to plan national programs for the optimal use of resources, spending on care and prevention of cardiovascular diseases.
- Assistance in preparing policies which promote healthy life styles and deal with other risk factors causing those diseases.
- Establishing an international network for promoting the issue of heart economics, disseminating research outcomes and international activities in the field of health economics and in particular cardiovascular diseases.
- Collection and dissemination of successful experiences in the field of economics of cardiovascular disease.
2. Requests the countries to initiate their national programs on economics of cardiovascular diseases which require :
- Establishing the group of specialists in the field of health economics and appropriately qualifying them to undertake this vital important role.
- Educating health care professionals, decision-makers and the community about issues related to heath economics in general and economics of cardiovascular diseases in particular.
- Dissemination of information about economics of cardiovascular diseases for the media to increase community awareness.
3. Requests the countries to communicate the information about heart economics to the highest leadership levels and to national policy - and strategy- makers to increase awareness and to give effect to the programs, and secure financial procedures and other support measures and to facilitate the issuance of related policies and legislations.
4. Calls upon all the countries to increase their current national spending on care of cardiovascular patients and its prevention at a rate which matches the current incidence rates in each country. This step will prove its cost-effectiveness and will lead to long-term saving as a result of reduction of incidence rates and the grave complications of such diseases.
5. Emphasizes the importance of activating the national plans and programs to combat the epidemic of cardiovascular diseases, and giving such programs a high priority.
6. Calls upon the countries to work towards reducing the incidence rates by 25% within 10 years (2008-2017).
7. Calls upon inclusion of religious and spiritual principles about health promotion to keep well the human heart and soul , in all educational curricula at all health and medical educational institutes concerned with education and qualification of health cadres within the comprehensive and integrated vision of the human soul .
8. Calls upon working towards promotion of women empowerment policies in the fields of heart health in an integrated form with all health systems frameworks and the national health promotion strategic plans in various fields : community , education , religious and economic ; with emphasis on the role of protection of women’s hearts through :
- Involvement in the cardiac care centers of religiously qualified people to undertake spiritual direction to revive and treat hearts.
- Finding an effective and easy mechanism to monitor data about prevalence of risk factors and cardiovascular diseases in women.
- Work towards enacting laws and regulations that promote women’s heart health.
- Directing health promotion programs towards changing attitudes and acquisition of the required skills to modify unhealthy behaviors and its integration in the educational curricula as well as monitoring activities and outcome achieved.
- Setting health education programs to qualify cadres in the field of women’s heart , to ensure spreading health awareness in the community.
- Recruitment of the media and mobilization of all efforts in this regards especially those directed to the youth.
9. Calls upon the member states and the organizations participating in the annual regional and international meetings to exchange experiences and provide the best practices and modules as well as review the programs made about the planned activities in economics of cardiovascular diseases.
10. Requests the Director General, Executive Board of the Health Minister’s Council for Cooperation Council States to draw the attention of the member states and the participating organizations such as the United Nations and European Union and the Arab League to this declaration.
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