From Bloomberg, a Recommitment To Improving Global Heart Health

It’s still hard to keep COVID from eclipsing all other health issues in the collective consciousness, but when it comes to global health risks in low and moderate-income countries (LMICs), data show that cardiovascular disease remains the No. 1 cause of death. More than 18 million people die from it each year.

Dr. Tom Frieden, former director of the CDC and current president and CEO of Resolve to Save Lives (RTSL), said, “The problem is worse than COVID at its worst,” despite the fact that it’s “quite preventable with a few interventions.” The organization he leads is committed to using three key solutions — limiting salt intake, treating hypertension, and eliminating trans fats — to prevent 100 million related deaths over the next 30 years.

In keeping with its data-driven approach, Bloomberg Philanthropies recently recommitted to promoting cardiovascular health – an issue that draws a surprisingly low 2% of global development health aid in LMICs. The grantmaker contributed $115 million to RTSL’s work on cardiovascular disease over the next five years, adding to $100 million in funding it provided in 2017.

The resources will help alleviate a comorbidity that has both health consequences and economic ones. The estimated financial fallout from heart attack and stroke in LMICs was $3.7 trillion between 2011 and 2025, or 2% of global GPD.

“Everyone else bring data”

Big picture, Bloomberg Philanthropies’ global public health work focuses on saving millions from dying of preventable causes in cities and LMICs, using strategic partnerships and proven strategies.

All of the initiatives within Bloomberg’s global health portfolio are data-driven, following the founder’s guiding philosophy: “In God we trust. Everyone else bring data.” To ensure the best data available from LMICs, the grantmaker’s work includes an ongoing Data for Health initiative, which collaborates with governments to improve the public health benchmarks that inform policies and determine outcomes.

Dr. Kelly Henning, who leads Bloomberg Philanthropies’ Public Health program, said the foundation has been supporting Resolve to Save Lives’ cardiovascular disease work since the organization’s inception five years ago, and that this latest $115 million will sustain support for five additional years. The new commitment adds to an initial $100 million commitment made in 2017 as part of a partnership with the Gates Foundation and the Chan Zuckerberg Initiative, bringing the total to date to $215 million.

Henning’s portfolio at Bloomberg includes a 16-year, $1 billion initiative to reduce tobacco use in LMICs, programs in obesity and drowning prevention, a 10-year commitment to reducing global road traffic deaths and injuries, and a maternal and reproductive health initiative focused on sub-Saharan Africa and Latin America.

To put the cardiovascular disease investment in context, over his lifetime, Mike Bloomberg’s overall funding to improve public health around the world weighs in at $3.3 billion through multiple vehicles including his foundation, corporate and personal philanthropy.

While it’s certainly not the largest tranche in Bloomberg’s global health giving, his commitment to cardiovascular disease work sets him apart among major funders. Frieden said that external funding for heart disease prevention in LMICs has stagnated since 2000, and currently “accounts for less than 2% of total development aid for health.”

Three interventions

Resolve to Save Lives focuses on three largely neglected interventions: reducing salt intake, eliminating artificial trans fats, and expanding the number of patients being treated for hypertension and high blood pressure. Henning said that while the three interventions haven’t changed since the initial grant, the success of each tactic has varied.

The hardest, she said, has been salt reduction, which “really requires multi-pronged strategies.” At the government level, countries must collaborate on public food, labeling and salt substitutes. While there’s been “good progress,” Henning said the environment must be supportive to making substitutes broadly and cheaply available within the larger goal of making “the default choice the healthiest.”

Blood pressure treatment protocols include medication and monitoring. Henning said existing funding through RTSL has already reached 7 million people through primary health interventions. The new funding puts the work on pace to reach more than 40 million patients in 31 countries by 2027.

And trans fat work has really taken off. Artificial trans fat, or TFA, is estimated to cause more than a half-million deaths globally each year, yet it can easily be eliminated and replaced by healthier alternatives.

The key to mitigation lies largely at the government level, by regulating packaged and processed foods. Programs like the REPLACE partnership, which RTSL started with the WHO in 2018 to eliminate industrial-produced trans fats, has resulted in protections for 30% of the global population in only three years. The goal now is a trans fat-free world by 2023.

Frieden highlighted that progress. “In the past five years, we've helped 32 countries pass trans-fats bans,” he said. Thirty-seven percent of the world’s nearly 3 billion people “now live in countries with trans-fat bans in effect or passed — compared to only 7% when we started this work.” Thanks to Bloomberg’s support, he said, “the days of artificial trans fat are numbered, and when it is gone, more than 17 million lives will be saved over the following 25 years.”

Partners in health

Henning said that the geographical focus lies in the countries where RTSL does a lot of work, like Bangladesh, China, Ethiopia, India, Nigeria, the Philippines, Thailand, Sri Lanka and Vietnam. Partnerships are managed by RTSL directly.

Global and regional partners include the World Health Organization (WHO), the Global Health Advocacy Incubator, the Johns Hopkins Bloomberg School of Public Health, the World Bank and Pan American Health Organization Partners, which regrants in regions covered by the Pan American Health Organization.

As an example of a successful collaboration, Frieden pointed to a technical partnership with the National Heart Foundation of Bangladesh. After RTSL and others advocated with the Bangladeshi government, the country aims to be trans fat-free by December 31 of this year, which brings along with it all the “terrific” things that means for preventing heart attacks, Frieden said.

All of a piece

Mike Bloomberg currently serves as the WHO’s Global Ambassador for Noncommunicable Diseases, a role that involves bringing attention to NCDs and rallying support for deescalating the fallout from chronic conditions like heart disease, as well as cancer, asthma and diabetes.

Other major philanthropies have thrown their support behind efforts to curb NCDs. For example, the Bill & Melinda Gates Foundation’s longtime advocacy work in tobacco control works to reduce tobacco-related mortality in LMICs. But during a raging pandemic, encouraging others to follow suit isn’t an easy lift.

It may help to view the work as all of a piece. Frieden noted that, “With the pandemic, there is a greater recognition that health and healthcare matters. If you don't have a more resilient population, then the risk from infectious disease will be even higher. One of the reasons COVID has killed so many people is that so many people were vulnerable to health problems, whether from emphysema from smoking, or poorly controlled diabetes or heart failure from poorly controlled hypertension.”

The data agree — and show that even as standalone life-saving efforts like reducing heart disease make progress on one front, they reduce barriers to progress on others.

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