Saving Lives from Preventable Disease: The Progress We’ve Made and the Challenges Ahead
Resolve to Save Lives 2023 annual letter
Covid caught the world off guard, and we continue to feel the repercussions of being unprepared. Economies are suffering, children are behind in school, and we are more divided than ever due to the politicization of science and the spread of misinformation.
As disheartening as this may appear, there are many rational grounds for hope! As Resolve to Save Lives begins our sixth year working to save lives and our first as an independent non-profit organization, we remain focused on our goals: To prevent 100 million deaths from cardiovascular disease and to make the world safer from epidemics.
By looking at the significant progress we’ve made together and the; perils before us, we can expand our reach as new possibilities emerge to save lives.
Working with partners, in the past year Resolve to Save Lives has made encouraging progress in our two program areas, Cardiovascular Health and Prevent Epidemics.
Cardiovascular disease remains the world’s leading killer, even during the peak of the Covid pandemic. High blood pressure alone kills more people each year than all infectious diseases combined. It increases risk of death from heart attack and stroke and leads to poorer outcomes from infectious diseases, including Covid. Simple, proven improvements in high blood pressure care can save more lives than any other medical intervention for adults.
We’ve partnered with 31 countries that have enrolled nearly 10 million people in hypertension control programs based upon World Health Organization (WHO) recommendations. Simple, the mobile app we developed to support large-scale hypertension and diabetes management programs, has been used in nearly 10,000 health centers to improve the care of more than 3 million patients. In the British Medical Journal Health and Care Informatics, we summarized important lessons learned from front-line health workers to create one of the most effective and widely used digital health tools for frontline health workers the world has ever seen.
The REPLACE initiative to eliminate the artificial chemical trans fat from the global food supply, which we develop and implement with WHO, provides tools for governments and the food industry to end the use of this toxic additive and thereby prevent heart attacks. The recent adoption of best-practice policies by Oman, Argentina, Egypt and Mexico brings the number of people protected from trans fat to 3.4 billion — 44% of the world’s population — and signals accelerated progress toward the global goal of elimination by the end of this year.
Cardiovascular disease remains the world’s leading killer, even during the peak of the Covid pandemic. High blood pressure alone kills more people each year than all infectious diseases combined.
Our cardiovascular health work also focuses on reducing salt consumption. An estimated 99% of people worldwide consume more than the WHO recommendation of 5 grams (one teaspoon) of salt per day. Decreasing salt intake reduces high blood pressure and prevents heart attacks and strokes. We continue to work with governments and industry to reduce salt in foods and make low-sodium alternatives readily available. We also monitor progress in this area from around the world. Singapore is innovating to increase intake of low-sodium alternatives, building on ground-breaking research by their Chinese colleagues and The George Institute demonstrating that increasing use of low-sodium salt saves lives.
As the world emerges from the peak of the pandemic, we risk repeating the cycle of panic and neglect. Covid revealed gaps in preparedness and response systems in nearly all countries. It showed that the harms of this neglect go far beyond health and include economic, educational, social and even political costs.
Along with public health leaders from 8 countries in Africa, we issued an analysis based on what we have learned over the past five years about how to accelerate preparedness. The key lessons about what is needed:
- Political leadership
- Multidisciplinary teams focused on improving preparedness
- Systematic tracking of progress implementing plans
- Meaningful metrics to drive continuous improvement, particularly the 7–1–7 target
- A country-led process that structures partnerships as part of a national plan to improve health security.
The second lesson of the five above comes from our multidisciplinary Acceleration Teams, which provide technical, policy, legal and program management support by embedding expert staff in ministries of health. They mobilize resources for preparedness at local, national and global levels and establish systems to enable countries to monitor and improve epidemic preparedness and response.
The fourth lesson led to our work with partners to develop the 7–1–7 target for improved detection, reporting, and control of health threats. Acceptance of 7–1–7 by global institutions is increasing. It is now being used to help structure grant applications and program goals in addition to helping countries rapidly improve their preparedness systems. Uganda demonstrated this during their recent successful control of Ebola, using 7–1–7 analysis to quickly identify areas for strengthening and improve systems in real time.
Covid revealed gaps in preparedness and response systems in nearly all countries. It showed that the harms of this neglect go far beyond health and include economic, educational, social and even political costs.
As interest in the 7–1–7 target continues to grow, we now host the 7–1–7 Alliance, a country-led global partnership providing technical assistance and financial support as well as a global community of practice to help countries achieve the 7–1–7 target. We are honored that Dr. Issa Makumbi, Director of the Uganda’s Public Health Emergency Operations Centre and Deputy Director of Uganda’s National Institute of Public Health, has agreed to serve as the inaugural Chair of the Technical Steering Group.
Despite this progress, major hurdles remain:
- More than a billion people with hypertension are not being treated effectively. Medication costs remain out of reach for many patients and primary health care systems. A focus on screening without enough attention to the need to establish effective treatment systems and support patients — to recognize that controlling blood pressure is the key indicator to track — undermines progress in many countries. And, most health information systems don’t effectively support the needs of health care providers, patients, or program managers.
- More than 4 billion people, mostly in Asia and Africa, remain unprotected from artifical trans fat in their food.
- Most people in the world consume more than twice the recommended amount of salt intake.
- There is limited national and global funding for cardiovascular health, despite heart attack and stroke being the leading cause of death globally and largely preventable.
- Funding to improve preparedness remains uncoordinated and erratic, often increasing only after an outbreak is detected.
- Even when funds are allocated for preparedness, they too often sit idle due to cumbersome processes, limited capacity, political barriers, and lack of understanding of and means to improve staff capacities (the need for staff more than stuff) and systems (the need for strong everyday systems not episodic attention).
- Distrust and politicization of health issues, including misinformation and disinformation, make progress in public health increasingly challenging.
As daunting as these challenges are, possibilities for the future far outweigh them!
An exciting area we are exploring is improving primary health care (PHC). Doing so can improve hypertension control and hasten the detection and control of outbreaks. Primary health care must become not only more accessible but also epidemic-ready. When an infectious disease is contained, it’s often due to well-coordinated action at the local level — alert clinicians with strong ties to the public health system, and community health workers who connect with patients and families. Epidemic-ready PHC can help rebuild trust, produce quick responses to outbreaks, and foster community-wide resilience. Major barriers include insufficient focus and funding and inadequate information systems, but the pandemic may open windows of opportunity in some countries for stepwise improvements. By 2024, we hope to obtain support and identify partner areas to pilot epidemic-ready primary health care in at least one place.
In the coming year, we also look forward to building on current momentum toward a trans fat free world. Pakistan, one of the countries with the largest remaining burden, China, Ethiopia, Nigeria, and other countries in Africa and Asia can save lives and reduce health care costs by banning artificial trans fat. Major manufacturers can join Cargill, which committed to eliminating trans fat from all its products by the end of 2023, and stop selling products that kill.
In keeping with the vision of stronger primary health care and more resilient communities, we are excited to see that many countries implementing hypertension control programs are moving toward nationwide expansion. With partners, we will continue to enhance policies that make health care more equitable and to extend the range of digital solutions that support both healthcare workers and patients. Addressing the affordability of care, particularly in Africa, must be a global priority.
Implementing programs to increase use of low-sodium salts and further expanding programs that make publicly procured and provided food healthy will provide a sound basis for further reduction of sodium intake.
The 7–1–7 Alliance will place countries at the center and help break both the panic-and-neglect cycle and the planning-and-more-planning cycle, shifting to a “find a problem, fix a problem” approach. With new commitments and resources, the world has the potential to substantially improve our collective defenses against microbial threats.
We are delighted to welcome Precious Matsoso to the Board of Resolve to Save Lives. We also welcome Dr. Iruka Okeke to the Board of the independent Resolve to Save Lives, Nigeria, which was registered in 2022. These leaders will help us elevate our vision and expand our impact in the years ahead.
Our progress would not be possible without the generous support of our donors, led by Bloomberg Philanthropies; the Bill and Melinda Gates Foundation; Chan Zuckerberg Initiative; #StartSmall; Stavros Niarchos Foundation; Skoll Foundation; Tambourine; Lyda Hill Philanthropies and others. Our funders recognize the power of rapid, scalable, and flexible action to accelerate progress against under-addressed public health threats. For this, my team and I are deeply grateful.
This year I was able to get back into the field and see our programs in action, as well as the way Covid has changed how we work in public health. I’m more confident than ever that RTSL’s approach and partners are what’s needed. We need stronger systems for the next health threat, and we need healthier populations to better combat threats that are sure to come.
Thank you for your commitment, involvement, and support helping create a safer and healthier world.
Learn more about Resolve to Save Lives at resolvetosavelives.org