Introduction and Overview

This report looks at what cardiovascular disease is, why we get it and what we can do to prevent and manage it by keeping our hearts healthy. We consider data on the impact that cardiovascular disease has on Torbay, the role of risk factors and inequalities, and the experiences of members of our communities, healthcare professionals and community organisations relating to cardiovascular disease. At the end we list some recommendations for all of us to help promote healthy hearts in Torbay.

Introduction from Dr Lincoln Sargeant, Director of Public Health

In the decade following the end of World War II it became clear that there was an epidemic of heart disease in the UK and other industrialised countries of North America and Europe. People were familiar with the “heart attack” since antiquity, but its victims were typically older men. From the late 1940s onwards, apparently healthy men and women were being stuck down in their prime in increasing numbers with each passing year. The impact was felt even more acutely because of the toll on the working age population already depleted by losses during the war.

It also emerged that during the war years heart disease had declined. The fact that disease patterns changed so quickly was an important clue that the causal factors behind the epidemic could be found. This in turn would point to effective treatment and prevention. These insights led to one of the triumphs of public health in the 20th century as heart disease rates fell progressively after peaking in the late 1960s and early 1970s, driving a decrease in overall death rates in adults.

However, this success is tempered by the recognition that declines have been slower for some groups and heart disease continues to be a major contributor to the gap in life expectancy seen between the most and least deprived areas in Torbay. Given that we have known how to prevent, diagnose and treat heart disease since the 1960s, why does it still persist as a cause of premature death and disability in so many of our communities?

This is the heart of the matter that my annual report addresses this year. Although we have made strides in understanding and preventing the behavioural and environmental factors causing heart disease we often overlook the social context of these factors. For example, following a heart-healthy diet entails more than just understanding the factual evidence of the benefits. Food ties us to our cultural heritage and traditions. It provides the backdrop to our important relationships and life events. Our eating patterns echo our social position in our community. Many of these influences on our diet are subconscious, and few of us make a habit of thinking about the health implications of each meal. There are also considerations about the availability and affordability of healthy food.

While we know broadly what a heart healthy diet is, our understanding of what that means for an individual, their family and social networks, is less clear. Simply providing the facts is not enough to ensure sustained change in behaviour. The same is true for other “lifestyle” risk factors like sedentary behaviour and smoking. If we want to reduce the burden of ill health, and the impact of disability on our residents and economy, we must apply the experience of what promotes heart health to our local context in Torbay. That involves working with individuals, health care providers, policy makers and communities to make sense of existing knowledge so it drives the desired actions and results.

Our recommendations highlight actions we can take in partnership with our local communities to promote heart healthy behaviours and environments. This is with the aim of enabling us all to have an equal chance to thrive physically, mentally, socially and economically, without the limitations of premature illness due to preventable heart conditions.