Putting cardiovascular disease at the heart of policymaking: Learning from research in the devolved nations

A slowing down of progress in tackling cardiovascular disease (CVD) means more lives meaningfully cut short due to preventable illness and worse quality of life for those living with CVD. What this data hides is that behind the top line figures exist deep and persistent inequalities. 

These figures are borne out by our own analysis across the devolved nations, which found that people in the most deprived communities are consistently far more likely to be living with – and more severely affected – by heart disease. Across each of the three blogs we found the following.

• In Scotland: GPs in the most deprived areas have 40 per cent more male patients and 80 per cent more female patients with cardiovascular disease, compared to GPs in the least deprived areas.
• In Wales:  People living in the most deprived areas are 1.58 times more likely to say their heart condition reduces their ability to carry out day-to-day activities, than those living in the least deprived areas, rising to 1.67 times among those under 75.
• In Northern Ireland: People in the most deprived fifth are 2.3 times more likely to have a long-term heart condition or angina, compared to those in the least deprived areas.

These are wide inequalities in a disease that shapes both how long people live and how well they live. While the causes are complex, there are a number of levers that can be pulled to reduce CVDs impact and prevalence. The rest of this blog sets out what governments can do, and why the upcoming elections make this a particularly important moment to act.

1. Access to high quality data covering primary and secondary care

Effective use of data should be the basis for any comprehensive strategy to address both health challenges and reduce inequalities – and CVD is no exemption. Data allows policymakers to have a clearer understanding of their patient population: how well conditions are being managed, if there any inequalities in access to and outcomes of care, present by sociodemographic characteristics (such as race, socioeconomic status or gender) or between areas. Without good primary care level data, many of these inequalities are likely to remain invisible until patients enter hospital.

Worryingly, not all of the devolved nations collect and use comprehensive primary care data to understand CVD risk factors, care access and quality. England carries out the Cardiovascular Disease Prevention Audit (CVDPREVENT), which provides detailed information on risk factors and CVD prevalence, at a very local level. Scotland, Wales and Northern Ireland are all some way behind.

Scotland's PCIS system is a huge step forward, but the data is not age-standardised – a significant gap, meaning that we can’t easily compare different areas with one another. PCIS is also missing some key data on known CVD risk factors such as obesity which would be valuable for strengthening and targeting public health efforts.

For Wales and Northern Ireland much of this data is already collected but is missing key information that would make it usable. For example, the number of patients with CVD is calculable but without knowing about the age distribution of the patients with CVD on GPs lists makes it impossible to compare GPs or even the same practices overtime. If this level of granularity was added – it could become an extremely valuable tool for policy makers, GPs and commissioners. 

2. Ambitious, well-resourced plans

Having high-quality, granular and regularly updated data enables policymakers to create detailed, ambitious plans that can turn the dial on CVD. The most successful CVD prevention plans both look to intervene at a population level, and to target resources at those who need the greatest support. Relatedly, alongside seeking to improve access to high-quality care, successful plans also seek to address the wider determinants of health, which tend to be the biggest driver of poor outcomes and inequalities in CVD. 

Each of the devolved nations has announced plans of various scope and ambition. While each of the cardiovascular plans (or the broader long-term disease plans in Scotland) focus primarily on treatment at a secondary care level, they do not do enough to meaningfully reduce both the impact of cardiovascular diseases and set out a strategy to meaningfully reduce disease prevalence. Plans that do not centre around prevention are unlikely to have a meaningful long-term impact.

Wales has announced an intention to become a ‘Marmot Nation’, which would embed health considerations into policy decision-making. If implemented effectively, this approach could shift the dial of not just cardiovascular disease but all non-communicable disease and tackle the deep health inequalities that are found in Wales, particularly in post-industrial areas in the south east. 

Invariably, in health systems which are politically directed (as is the case in all of the devolved nations), ambition without sustained political commitment is fragile. Plans that do not survive a change of government cannot deliver the long-term change that CVD requires. This is why the upcoming elections in Scotland and Wales matter so much for the future of CVD prevention and management. 

3. Building on the current system 

Whatever the elections bring, incoming governments must build on what already exists rather than pursuing large, sweeping changes. Reorganisation of health system governance are unlikely to generate substantial benefits and will come at the cost of sustained focus on what works to drive improvements on headline targets such as cutting premature CVD mortality.

We know what health and healthcare systems need to do to reduce the burden of heart disease. Identifying, monitoring and treating high-risk patients – particularly within primary care – will help prevent heart attacks, strokes and deaths. Primary care is pivotal to this, and those working within it need the wider health system to better support them in identifying patients most at risk. 

Yet healthcare can only go so far. The majority of heart disease is preventable – policies that improve access to good food, encourage physical activity and reduce smoking will ultimately do more to cut heart disease risk than anything the health system alone can offer.

4. Health and healthcare are a priority for voters – it should also be for any future government

Health is a priority for voters - and the upcoming elections in Scotland and Wales give political parties a clear opportunity to show they are serious about it.  Recent YouGov polling shows health ranks fourth, or joint third in Wales, among the most important issues facing the country. Voters want to know what political parties will do to improve not just the NHS, but health more broadly. 

CVD is a leading cause of death, a major driver of health inequalities and a significant burden on health systems. Any party genuinely serious about the nation's health cannot treat it as an afterthought – it demands targeted, sustained political commitment. Voters have made clear that health matters to them; the question now is whether the political will exists to match it.