March 2001 Insights Health Issue #1

Back to Insights Health #1

Prevention is better than cure
Tackling cardiovascular disease in the Seychelles

The Republic of Seychelles in the Indian Ocean has developed rapidly over the last 30 years, partly due to booming tourism. GDP per capita increased in real terms from $2927 in 1980 to $5731 in 1999. In that time, infectious diseases have been tamed and infant mortality has dropped from 50 to 10 per 1000 live births. As a result, the absolute number of people in their 30s and 40s has doubled over the last 20 years (see Figure 1). What challenges does this present for health services?

The 30 to 50 age group has an increased risk of NCDs and mortality rates from heart disease and stroke have risen. Vigorous and early prevention programmes can curb the incidence of cardiovascular disease (CVD). Recognising this, the Ministry of Health established a research and prevention programme in the late 1980s in collaboration with the University Institute of Preventive Medicine of Lausanne, Switzerland.

Baseline surveys for this programme in 1989 and 1994 (see Table 1) showed that the prevalence of high blood pressure, obesity (women), smoking (men) and raised blood cholesterol were at least as high as in Western countries. They also confirmed that high blood pressure, elevated cholesterol and diabetes were major contributors to heart attacks and strokes in the Seychelles.

Table 1

In response, the Ministry of Health set up the Unit for Prevention and Control of CVD and initiated a countywide prevention programme. This involves:

• mass media campaigns to raise awareness of heart disease, high blood pressure and diabetes, to highlight the risks of smoking, obesity and inactivity, and to promote healthy diets and lifestyles

• high profile events for World No Tobacco Day, Diabetes Day and Heart Day

• workplace education and screening programmes for high blood pressure and diabetes

• screening and counselling for obesity and high blood pressure as part of the routine health programme in all schools

• educational programmes on healthy lifestyles in primary and secondary schools.

The programme targets high-risk adults through 'heart health clubs' at health centres throughout the country. They provide in-depth information to patients with high blood pressure and diabetes. Sessions stress the need to adopt a healthy lifestyle and diet and to take prescribed medication. A national register of all patients with high blood pressure and diabetes includes annually updated medical details, to allow health services to identify those most at risk and improve clinical management.

Successful aspects of the programme include:

• community involvement in many prevention activities

• coalitions of key partners favouring healthy lifestyles, such as government officials and local corporations through sponsorship of events

• support from international health organisations, facilitating the distribution of health messages through the electronic media

• sustained health education through the single television and radio channel which has a commitment to educational programming.

It is difficult to distinguish specific impacts of this programme from the effects of external influences, such as the pressure to adopt a 'Western' lifestyle. A study has shown that knowledge about CVD among the population is good and that smoking prevalence has stabilised. However, a high rate of childhood obesity and poor control of high blood pressure and diabetes in many patients show that there is much room for improvement. The challenge is to ensure the continuation and development of the prevention programme. This will require:

• new social norms which favour healthy lifestyles, including body weight control, regular physical activity and a healthy diet

• multi-sectoral interventions to provide an environment conducive to healthy lifestyles, such as improved availability of healthy foods and public sports facilities

• continued funding for prevention in the face of economic pressures and increasing demand for curative care.

Pascal Bovet
Ministry of Health
PO Box 52
Victoria
Seychelles
T: +248 388 000
F: +248 224 792
iumsp@seychelles.net