el trabajo brasilero en prevencion y relaciones internacionales
The 6th International Conference on Preventive Cardiology convened more than 700 international participants to discuss how
clinical practice, community intervention, and policy development can promote
global heart health. At those who attended head home, we must ask ourselves:
What did we learn? What next steps will we take? What concrete actions will
result? What will have changed in four years, at the next conference? We invite
all of our global colleagues to utilize ProCOR as a forum in which to continue
and expand the conference, and to discuss these important questions.
________
"Protecting the heart of global development" was the theme of the 6th
International Conference on Preventive Cardiology in Foz do Iguassu, Brazil (May
21-25, 2005). The scientific program ranged from genomics to public health, and
demonstrated a broad concept of preventive cardiology that extended beyond
medical care to include community interventions and policy development. No
single risk factor, subset of countries, sector of society, or preventive
approach holds the key to global heart health. Rather, everyone, working
together in complementary ways and integrated into cooperative efforts, is
necessary in order to address the global burden of cardiovascular disease.
Only half of the world's countries have surveillance systems. "We can't guide
the development of policy, and we can't make wise decisions about the allocation
of scarce health resources, unless we track trends in health status," said Ruth
Bonita, WHO. "Using this information, we can develop appropriate and effective
interventions and evaluate them." WHO's STEPwise approach assists countries in
collecting information about NCD risk factors in their unique settings
(www.who.int/chp/steps> or email rileyl@who.int)
Surveillance data paves the way for policy development. Less than 50% of
countries have a national NCD policy; less than 30% have a CVD plan, and less
than 40% have a tobacco plan. Surveillance data can be incorporated into
successful strategies that place heart health on the political agenda. Sylvie
Stachenko, Canada, reminded attendees that "we need to communicate with policy
makers in plain language that helps them understand the urgency. Tell them the
stories. Use reports and important documents. Engage the media in publicizing
the problem. Link the heart health agenda to other policy agendas. Make the
economic case--show how policies will translate to reduced burden on health care.
But always insist that economics are not more important than health." Dr.
Stachenko emphasized the roles of government, the private sector, industry,
NGOs, and civil society advocates. "By educating the public, we can build
consumer demand, which in turn can drive policy development. Health ministries
need to take a stewardship role in rallying other players, but a heart-healthy
society is a shared effort."
While policy creates environmental change, successful population approaches are
delivered in partnership with communities. Working with communities requires
knowing and valuing their cultures, contexts, and dynamics. Multi-factoral
approaches work better than single approaches; a program addressing physical
activity and nutrition will produce more benefit than a physical activity
program alone. Engaging a range of sites--home, workplace, schools--further
increases change.
Brian O'Connor, Canada, outlined strategies for population-based programs,
including community mobilization and education, social marketing and media,
health promotion programs, alliances and partnerships, and involvement of the
community in policy making. Examples of interventions from the world can be
reviewed online at www.internationalhearthealth.org. The social determinants of
health--risk conditions in which people live--are an important component of
community health programming. Dr. O'Connor pointed out that "many of the tools
we develop are sophisticated and can't reach people living on the margin.
Approaches should be tailored to take this into consideration.
Partnerships with communities produce benefits beyond improved health status.
Communities that participate in planning develop a sense of ownership that
increases the likelihood of success and sustainability. Leadership and other
community capacity such as advocacy and planning skills can be transferred to
other areas and contribute to a healthier environment. But building an
infrastructure requires a sustained and committed effort and willingness to
share control of the agenda. "The community is not a laboratory," Dr. O'Connor
warned. "Don't take the data and depart. Don't patronize them. Engage them in
the process."
Darwin Labarthe, USA, examined the role of physicians and the choices that they
face: "Rescue the individual, report accumulated cases, or respond to community
needs. All are essential." Physicians can influence health on many levels--by
promoting health for all, encouraging healthy lifestyles for their patients,
identifying and treating underlying conditions, diagnosing and treating CVD,
preventing occurrences, and enhancing quality of life for those with CVD."
This shift in the physician's role calls for a redefinition of primary care,
noted David MacLean, Canada. "Primary care is multidisciplinary and assumes an
active role in chronic disease prevention. Physicians can enhance preventive
practice by utilizing multiple approaches." Noting that for many physicians
"their idea of preventive medicine is vaccination," Dr. MacLean described a
Russian polyclinic where doctors with minimal resources nevertheless were able
to successfully manage their patients' CVD risk.
It is encouraging that this international conference on preventive cardiology
addressed issues that extended far beyond the physician's examination room or
the hospital's catheterization lab.
But questions remain. What have we learned during these days of discussions?
What next steps will each of us take to translate what we learned into action?
In four years, at the next conference, what will have changed?
Aloyzio Achutti, Brazil, reminded participants that "Our scientific meetings
must be permanent. It is important for us to stay connected through a virtual
community. The technical resources are already available and accessible.
Regional networks can be connected into a global network. Sharing information
creates a connection that leads to mutual support and empowerment, for example
the development of multi-centric research opportunities. There are many
potential friends hidden by traditional communication barriers and
institutional, economic, social, cultural and political restraints."
It is our hope that those who attended the conference and those who did not will
use ProCOR, AMICOR, and other electronic networks as a way to continue and expand the conversation, introduce new
topics, challenge one another, stay connected, and continue the global dialogue
until we have achieved our goals.
Catherine Coleman
Editor in Chief, ProCOR
Porto Alegre, Brazil demonstrates a model of multi-sectoral partnerships and multi-level approaches to promote cardiovascular health. Other cities
and countries are encouraged to share their models through ProCOR in order to inform and inspire the efforts of others.
________________
Nurses and nutritionists, epidemiologists and neurologists, cardiologists and
communicators, primary care physicians and public health professionals,
government officials and staff of NGOs, recently convened in Porto Alegre,
Brazil, to discuss the city's model of CVD prevention and control. The
participants represented a microcosm of the sectors of society that contribute
to health. In Porto Alegre, multi-sectoral partnerships bring together diverse
groups to promote health in multidisciplinary ways and on multiple levels.
National policy, community interventions, and medical care-family medicine,
primary care, specialists, and emergency-are working together to develop a range
of innovative programs that serve the poorest pockets of Porto Alegre and the
richest.
The International Meeting on Cardiovascular and Cerebrovascular Disorders
Prevention and Control in Porto Alegre, Brazil on May 19 was convened by Dr.
Aloyzio Achutti, Amicor, and Dr. Jefferson Gomes Fernandes, Director, Institute
of Education and Prevention, Hospital Moinhos de Ventos. Participants from
World Health Organization; Brazil's Ministry of Health; Hospital Moinhos de
Ventos in Porto Alegre, the Institute of Research and Prevention, AMICOR, and
ProCOR demonstrated the power of linking health care with social change.
Underlying Porto's Alegre's activities is the support of the Ministry of Health.
On the national level, Brazil is putting in place legislation and policies that
provide impetus to efforts to create healthy environments. Brazil has the largest public health system in the world. Brazil's national
health policy is currently in final review by its Health Assembly, and free nicotine
replacement therapy has just become become part of the public health system. On May
25, a national day promoting physical activity and nutrition was celebrated
across the country.
A "quality of life" map of each of the more than 2300 census blocks in Porto
Alegre guides the city's planning. Indicators such as age, literacy,
employment, electricity, number of inhabitants, access to sewage disposal and
garbage pickup, presence of health care facilities and their capacity to meet
demand, are analyzed and assigned to each census block in values ranging from 1
(worst) to 5 (best). The census blocks can be reviewed individually, providing
an immense amount of detail, or can be aggregated into clusters. Indicators
also can be overlaid onto one another in various combinations.
The outcomes of this planning target the specific needs of each area of the
city. For example:
* On an outlying island, programs to provide water treatment, sewage
disposal, and electricity accompany a family medicine clinic's services, which
include home visits to each resident by a trained member of the clinic staff.
* The hospital is building its new laundry facility in a poor area of the
city. Although the facility is several miles away from the hospital, the
location was chosen because it will create more than 300 jobs for nearby
residents and the hospital realizes that health benefits will follow when more
employment is available.
* A 24-hour emergency clinic recently was established in an empty building
in an area of Porto Alegre that experiences a high incidence of violence and
injuries. The Institute of Education and Prevention has developed a one-year
program for individuals planning to enter medical school which includes an
orientation to community health and a patient-focused approach to their future
profession.
* Primary care, dental care, and a wellness clinic are available in a
hospital branch located in an upscale shopping, increasing ease of access to
preventive services by including health care among residents' everyday errands.
I was struck by the balance I saw at Hospital Moinhos de Vento between their
successful strategy of creating a "hotel" atmosphere in their private hospital
facility and their success in providing the same level of care at the public
hospital. Many cardiologists with whom I spoke emphasized the importance of
balancing an emphasis on the use of clinical skills and multi-disciplinary
medical management of cardiovascular disease while incorporating the latest
technology in appropriate ways. The "rush to refer" that is overtaking much of
American medicine did not seem to dominate the model of care described at
Hospital Moinhos de Vento. One physician asked, "Why should we prescribe the
latest, more effective, most marketed drug when older medications work better,
are cheaper, and have a longer track record." Another physician said, "We need
to recognize the important role of non-physicians. And we need to learn in new
areas that were not part of our training, like how to counsel a patient on
physician activity or nutrition." While the philosophy and vision at this
hospital is not representative of all medical institutions in the region or the
country, I was told that it is not the only Brazilian example of successful
integration of clinical care and community, of technology and the "art of
healing."
Prior to the conference, on May 17, I celebrated the 8th anniversary of AMICOR
with Dr. Achutti and his wife, Dr. Valderes Robinson, also a cardiologist. Dr.
Achutti founded AMICOR in 1997 to establish a network of cardiologists,
physicians, and health workers from Brazil, Latin America, and other countries.
Daily he links them to locally relevant information from Latin American and
international sources. Information is presented in Portuguese, Spanish, or
English. Dr. Achutti is currently exploring the potential of blogs to transfer
information among networks and he maintains an extensive email distribution
list. ProCOR and AMICOR are part of an increasingly linked "network of
networks" around the globe, in which interpersonal, institutional, regional,
national, and global networks intersect with each other at common points of
interest to proliferate the sharing of knowledge and connections among people.
Thank you to the many Brazilian colleagues who made me feel welcome, patiently
explained what was unfamiliar and enthusiastically explored what was possible. I
especially thank Dr. Achutti for his faith in all kinds of connections and his
ability to make them happen.
clinical practice, community intervention, and policy development can promote
global heart health. At those who attended head home, we must ask ourselves:
What did we learn? What next steps will we take? What concrete actions will
result? What will have changed in four years, at the next conference? We invite
all of our global colleagues to utilize ProCOR as a forum in which to continue
and expand the conference, and to discuss these important questions.
________
"Protecting the heart of global development" was the theme of the 6th
International Conference on Preventive Cardiology in Foz do Iguassu, Brazil (May
21-25, 2005). The scientific program ranged from genomics to public health, and
demonstrated a broad concept of preventive cardiology that extended beyond
medical care to include community interventions and policy development. No
single risk factor, subset of countries, sector of society, or preventive
approach holds the key to global heart health. Rather, everyone, working
together in complementary ways and integrated into cooperative efforts, is
necessary in order to address the global burden of cardiovascular disease.
Only half of the world's countries have surveillance systems. "We can't guide
the development of policy, and we can't make wise decisions about the allocation
of scarce health resources, unless we track trends in health status," said Ruth
Bonita, WHO. "Using this information, we can develop appropriate and effective
interventions and evaluate them." WHO's STEPwise approach assists countries in
collecting information about NCD risk factors in their unique settings
(www.who.int/chp/steps> or email rileyl@who.int)
Surveillance data paves the way for policy development. Less than 50% of
countries have a national NCD policy; less than 30% have a CVD plan, and less
than 40% have a tobacco plan. Surveillance data can be incorporated into
successful strategies that place heart health on the political agenda. Sylvie
Stachenko, Canada, reminded attendees that "we need to communicate with policy
makers in plain language that helps them understand the urgency. Tell them the
stories. Use reports and important documents. Engage the media in publicizing
the problem. Link the heart health agenda to other policy agendas. Make the
economic case--show how policies will translate to reduced burden on health care.
But always insist that economics are not more important than health." Dr.
Stachenko emphasized the roles of government, the private sector, industry,
NGOs, and civil society advocates. "By educating the public, we can build
consumer demand, which in turn can drive policy development. Health ministries
need to take a stewardship role in rallying other players, but a heart-healthy
society is a shared effort."
While policy creates environmental change, successful population approaches are
delivered in partnership with communities. Working with communities requires
knowing and valuing their cultures, contexts, and dynamics. Multi-factoral
approaches work better than single approaches; a program addressing physical
activity and nutrition will produce more benefit than a physical activity
program alone. Engaging a range of sites--home, workplace, schools--further
increases change.
Brian O'Connor, Canada, outlined strategies for population-based programs,
including community mobilization and education, social marketing and media,
health promotion programs, alliances and partnerships, and involvement of the
community in policy making. Examples of interventions from the world can be
reviewed online at www.internationalhearthealth.org. The social determinants of
health--risk conditions in which people live--are an important component of
community health programming. Dr. O'Connor pointed out that "many of the tools
we develop are sophisticated and can't reach people living on the margin.
Approaches should be tailored to take this into consideration.
Partnerships with communities produce benefits beyond improved health status.
Communities that participate in planning develop a sense of ownership that
increases the likelihood of success and sustainability. Leadership and other
community capacity such as advocacy and planning skills can be transferred to
other areas and contribute to a healthier environment. But building an
infrastructure requires a sustained and committed effort and willingness to
share control of the agenda. "The community is not a laboratory," Dr. O'Connor
warned. "Don't take the data and depart. Don't patronize them. Engage them in
the process."
Darwin Labarthe, USA, examined the role of physicians and the choices that they
face: "Rescue the individual, report accumulated cases, or respond to community
needs. All are essential." Physicians can influence health on many levels--by
promoting health for all, encouraging healthy lifestyles for their patients,
identifying and treating underlying conditions, diagnosing and treating CVD,
preventing occurrences, and enhancing quality of life for those with CVD."
This shift in the physician's role calls for a redefinition of primary care,
noted David MacLean, Canada. "Primary care is multidisciplinary and assumes an
active role in chronic disease prevention. Physicians can enhance preventive
practice by utilizing multiple approaches." Noting that for many physicians
"their idea of preventive medicine is vaccination," Dr. MacLean described a
Russian polyclinic where doctors with minimal resources nevertheless were able
to successfully manage their patients' CVD risk.
It is encouraging that this international conference on preventive cardiology
addressed issues that extended far beyond the physician's examination room or
the hospital's catheterization lab.
But questions remain. What have we learned during these days of discussions?
What next steps will each of us take to translate what we learned into action?
In four years, at the next conference, what will have changed?
Aloyzio Achutti, Brazil, reminded participants that "Our scientific meetings
must be permanent. It is important for us to stay connected through a virtual
community. The technical resources are already available and accessible.
Regional networks can be connected into a global network. Sharing information
creates a connection that leads to mutual support and empowerment, for example
the development of multi-centric research opportunities. There are many
potential friends hidden by traditional communication barriers and
institutional, economic, social, cultural and political restraints."
It is our hope that those who attended the conference and those who did not will
use ProCOR, AMICOR, and other electronic networks as a way to continue and expand the conversation, introduce new
topics, challenge one another, stay connected, and continue the global dialogue
until we have achieved our goals.
Catherine Coleman
Editor in Chief, ProCOR
Porto Alegre, Brazil demonstrates a model of multi-sectoral partnerships and multi-level approaches to promote cardiovascular health. Other cities
and countries are encouraged to share their models through ProCOR in order to inform and inspire the efforts of others.
________________
Nurses and nutritionists, epidemiologists and neurologists, cardiologists and
communicators, primary care physicians and public health professionals,
government officials and staff of NGOs, recently convened in Porto Alegre,
Brazil, to discuss the city's model of CVD prevention and control. The
participants represented a microcosm of the sectors of society that contribute
to health. In Porto Alegre, multi-sectoral partnerships bring together diverse
groups to promote health in multidisciplinary ways and on multiple levels.
National policy, community interventions, and medical care-family medicine,
primary care, specialists, and emergency-are working together to develop a range
of innovative programs that serve the poorest pockets of Porto Alegre and the
richest.
The International Meeting on Cardiovascular and Cerebrovascular Disorders
Prevention and Control in Porto Alegre, Brazil on May 19 was convened by Dr.
Aloyzio Achutti, Amicor, and Dr. Jefferson Gomes Fernandes, Director, Institute
of Education and Prevention, Hospital Moinhos de Ventos. Participants from
World Health Organization; Brazil's Ministry of Health; Hospital Moinhos de
Ventos in Porto Alegre, the Institute of Research and Prevention, AMICOR, and
ProCOR demonstrated the power of linking health care with social change.
Underlying Porto's Alegre's activities is the support of the Ministry of Health.
On the national level, Brazil is putting in place legislation and policies that
provide impetus to efforts to create healthy environments. Brazil has the largest public health system in the world. Brazil's national
health policy is currently in final review by its Health Assembly, and free nicotine
replacement therapy has just become become part of the public health system. On May
25, a national day promoting physical activity and nutrition was celebrated
across the country.
A "quality of life" map of each of the more than 2300 census blocks in Porto
Alegre guides the city's planning. Indicators such as age, literacy,
employment, electricity, number of inhabitants, access to sewage disposal and
garbage pickup, presence of health care facilities and their capacity to meet
demand, are analyzed and assigned to each census block in values ranging from 1
(worst) to 5 (best). The census blocks can be reviewed individually, providing
an immense amount of detail, or can be aggregated into clusters. Indicators
also can be overlaid onto one another in various combinations.
The outcomes of this planning target the specific needs of each area of the
city. For example:
* On an outlying island, programs to provide water treatment, sewage
disposal, and electricity accompany a family medicine clinic's services, which
include home visits to each resident by a trained member of the clinic staff.
* The hospital is building its new laundry facility in a poor area of the
city. Although the facility is several miles away from the hospital, the
location was chosen because it will create more than 300 jobs for nearby
residents and the hospital realizes that health benefits will follow when more
employment is available.
* A 24-hour emergency clinic recently was established in an empty building
in an area of Porto Alegre that experiences a high incidence of violence and
injuries. The Institute of Education and Prevention has developed a one-year
program for individuals planning to enter medical school which includes an
orientation to community health and a patient-focused approach to their future
profession.
* Primary care, dental care, and a wellness clinic are available in a
hospital branch located in an upscale shopping, increasing ease of access to
preventive services by including health care among residents' everyday errands.
I was struck by the balance I saw at Hospital Moinhos de Vento between their
successful strategy of creating a "hotel" atmosphere in their private hospital
facility and their success in providing the same level of care at the public
hospital. Many cardiologists with whom I spoke emphasized the importance of
balancing an emphasis on the use of clinical skills and multi-disciplinary
medical management of cardiovascular disease while incorporating the latest
technology in appropriate ways. The "rush to refer" that is overtaking much of
American medicine did not seem to dominate the model of care described at
Hospital Moinhos de Vento. One physician asked, "Why should we prescribe the
latest, more effective, most marketed drug when older medications work better,
are cheaper, and have a longer track record." Another physician said, "We need
to recognize the important role of non-physicians. And we need to learn in new
areas that were not part of our training, like how to counsel a patient on
physician activity or nutrition." While the philosophy and vision at this
hospital is not representative of all medical institutions in the region or the
country, I was told that it is not the only Brazilian example of successful
integration of clinical care and community, of technology and the "art of
healing."
Prior to the conference, on May 17, I celebrated the 8th anniversary of AMICOR
with Dr. Achutti and his wife, Dr. Valderes Robinson, also a cardiologist. Dr.
Achutti founded AMICOR in 1997 to establish a network of cardiologists,
physicians, and health workers from Brazil, Latin America, and other countries.
Daily he links them to locally relevant information from Latin American and
international sources. Information is presented in Portuguese, Spanish, or
English. Dr. Achutti is currently exploring the potential of blogs to transfer
information among networks and he maintains an extensive email distribution
list. ProCOR and AMICOR are part of an increasingly linked "network of
networks" around the globe, in which interpersonal, institutional, regional,
national, and global networks intersect with each other at common points of
interest to proliferate the sharing of knowledge and connections among people.
Thank you to the many Brazilian colleagues who made me feel welcome, patiently
explained what was unfamiliar and enthusiastically explored what was possible. I
especially thank Dr. Achutti for his faith in all kinds of connections and his
ability to make them happen.
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