A heart-healthy and "stroke-free" world through policy development, systems change, and environmental supports: a 2020 vision for sub-Saharan Africa.

The vision of a heart-healthy and "stroke-free" world is achievable through the aggressive prevention and control of cardiovascular risk factors. In sub-Saharan Africa, a region plagued by infectious and parasitic diseases, nutritional deficiencies, and excessive maternal and perinatal morbidity and mortality, the prevention of cardiovascular diseases (CVD) and risk factors is rarely on the public health agenda. In Africa, however, as recently documented by the World Health Organization's Africa Regional Office, CVD and other chronic non-communicable diseases are on the increase and already represent a significant burden on public health services. Age-specific mortality and morbidity associated with CVD and chronic diseases are higher in sub-Saharan Africa than in established market economies. Correspondingly, adverse trends in risk factor profile are beginning to appear especially in many urban centers in sub-Saharan Africa. Addressing and reversing these trends will take more than just targeting individuals and their behaviors and lifestyle choices. More importantly, to support heart-healthy choices, emphasis must be placed on policy development, systems changes, and issues in the social environment factors such as the need to strengthen legislation and regulatory mechanisms, which control the leading risk factors (eg, tobacco, physical inactivity, and poor nutrition). We must develop and conduct heart-healthy and "stroke-free" initiatives to take place in diverse community settings: schools, worksites, communities, and healthcare systems. In addition, public health capacity and infrastructure must be strengthened to provide adequate surveillance and the assurance that best practices are implemented. Action is needed to integrate health promotion, risk factor control and disease prevention within the primary healthcare setting. Above all, population-based approaches must be used to promote education and awareness of the importance of CVD risk factors. In sub-Saharan Africa, where most people have no more than one CVD risk factor, a unique opportunity exists for primordial prevention, ie, preventing the development of risk factors in the first place. The policy and environmental change strategies discussed provide a road map to a heart-healthy and "stroke-free" future.