International Circulation: Prevention has been identified as the key factor in the prevention and control of cardiovascular disease. Are there any differences for developed and developing countries ? Can you elaborate on this ?

Prof. Shanthi: Yes， prevention is very important for both developed and developing countries， because particularly for cardiovascular disease， about 80% cardiovascular disease can be prevented. In order to prevent them， you need to have two kinds of strategies;  strategies that have an impact on the on the whole population， and those that impact on people who are at high risk of developing cardiovascular disease. You need to have both types of strategies in order to prevent cardiovascular disease. One kind of strategies will not be adequate， so you ask me if there are any features in the developing countries， different from the developed. Developing countries need to combine the two approaches， it’s very important. Up to now， they have been managing high risk people in healthcare system， that’s not enough. You need to have prevention for the high risk group and prevention for the whole population， by focusing on risk factors， like tobacco，  salt， fat and sugar in food， and physical inactivity. Likewise， you have to increase the healthcare budget so that the needs of those  with cardiovascular disease and those at high risk can be equitably taken care of . ，. If you try to only to do the high risk strategy， they will not be able to afford it. So particularly for developing countries， it’s very important to combine the two approaches.

International Circulation: Could you give us some advice on the cardiovascular disease prevention in China?

Prof. Shanti: Okay， for a country like China， with a very large population， prevention is key. It is  very important， and critical for cardiovascular disease control. Policies for prevention must focus on on risk factors， for example， tobacco， unhealthy diet， and physical inactivity. People can try to change behaviors to take physical activity， healthy diet， not to smoke， but it’s not easy for people to change behavior， you need government action， you need government policy to create a conducive environment. Tobacco products should be priced  high， so that people cannot afford it， for their own goods. You should not advertise tobacco products ， should not allow company to advertise， these are decisions that have to be taken by the government. Aother example is salt; salt is in processed food. When people eat processed and prepared food they have no control over the salt content. Government can have regulations for food industry or voluntary agreements with food industry to reduce salt in processed food. . Industry， the whole cooperate sector， they have a social responsibility to care about the people.

Industry and business， they make profits， there is nothing wrong with that， but they must also look after the  health of the population. 

Helathy food that protect peoples health such as fruit and vegetables are very expensive.  People cannot afford them . You need to bring down the price of healthy food and make them readily available. As for physical activity， if you want people to take physical activity， you need to set up safe area， walking parks， cycling paths， parks for children to play. Physical activity is very important for all age groups. And the important thing is that， if you take appropriate action against tobacco， unhealthy diet， and physical inactivity， diseases other than heart disease and stroke can also be prevented ， for example diabetes， cancer and respiratory disease. . So government needs to take action policy action to address behavioural risk factors at the upstream levels ， as it is win-win situation and will impact on many major noncommunicable diseases.  .

As China has a very large population it is a challenge to provide equitable health care to people. It is encouraging to see more commitment from the government. At a minimum universal coverage need to be provided for a set of essential services in PHC. Access to basic medical services is a fundamental human right. There is also the need to use available resources more efficiently . For example for cardiovascular disease management， while a total risk approach to prevention of cardiovascular disease is more cost effective than a single risk factor approach.  This morning in collaboration with Prof Liu Lisheng and the Chinese Hypertension Society and APSH we conducted a workshop for primary health care workers to introduce them to this approach. There is a new tool for this purpose the WHO/ISH risk prediction charts which can be used even in low resource settings. 

International Circulation: The last question， in your opinion， why is it so important to combine the population based strategy and strategies targeting  high risk groups ?

Prof. Shanthi : Okay， first thing to remember is you need to both strategies for all countries. You can’t have one without the other， because if you have population based strategy， this is very good， and this is very cost-effective. There are WHO tools such as the Framework Convention on Tobacco control and Global Strategy on Diet Physical Activity and Health which can facilitate population wide prevention. Population based strategies that address tobacco use， unhealthy diet， physical inactivity， will prevent not only heart attcks and strokes ， as I said， they also prevent cancer， they also prevent diabetes and chronic respiratory disease. So Population strategy is very important， however， you also need to complement them with  high risk strategies to prevent disease in people at high risk. It is important to deliver high risk strategies using cost effective approaches.