I was invited to give a talk at the World Cardiology Congress on lessons from diabetes and health systems that might be of use for cardiology. An interesting opportunity and when I found out that my co-Investigators Albertino Damasceno and Jaime Miranda would also be there I saw it as an added advantage to be able to see them and catch up on COHESION.
On my flight to Mexico, the Congress was in Mexico City, the person sitting next to me on the flight asked if I was going to Mexico on holiday and I said no that I was going to a Congress. They asked which Congress and I said a cardiology congress. «Ah so you are a cardiologist?», my neighbour asked. «No» was my answer. «Then what kind of doctor are you?», was his retort. «Actually, I am not a doctor, I work in public health and health systems», I replied and started describing what I actually do. Luckily the bewilderment of my fellow rowmate was interrupted by the all too important question by the flight attendant͞, «Chicken or pasta?» At which point we wished each other a pleasant meal and that was the end of our interaction.
That brief contact with my fellow traveller highlighted many things. One, the view of health as that of a doctor’s domain. Secondly, that public health is a misunderstood concept and people outside the health arena do not really understand what it means. Another issue is that for many people when they hear a disease, e.g. cardiology, they see this as something that doctors and medicine can fix, versus a large societal health issue that requires multiple actors to address within and outside the health system. Finally, that I need to find a better way of explaining what I do…
These issues are essential to highlight based on this somewhat trivial interaction in that at the World Cardiology Congress many of the sessions were geared towards issues that could not have been further away from what my travel companion imagined what cardiology and a cardiology congress entailed. I attended interesting discussions on tobacco, alcohol, health systems and specificities of heart disease in different parts of the world, e.g. Africa versus Latin America. All of the presentations had one thing in common, that the COHESION project is well and truly at the heart of the matter.
To give you an example why I say that. The sessions discussing tobacco, alcohol or obesity or those discussing hypertension management highlighted that these phenomena once thought of as being only found in high-income countries have now become global issues impacting all strata of populations within and between countries. In parallel certain countries face this burden as well as the burden of cardiovascular disease linked to infectious agents such as Rheumatic Heart Disease. For an excellent review of the challenges of cardiovascular disease in poor populations see http://www.ncbi.nlm.nih.gov/pubmed/27297348 which Jaime Miranda contributed to. These examples highlight the double burden of disease as a challenge, but very few of the presentations or discussion highlighted what could be done. Many described possible avenue for improvement: strengthening health systems, better health promotion and prevention activities, the need for policy interventions, better training of health professionals, task shifting, use of «m» and «e» health, etc. None of the presentations I attended mentioned two of the cornerstones of the COHESION project namely Primary Health Care or the community.
This made me realise the importance of the COHESION project in not only addressing the specific NCDs and NTDs we are working on, but also wider health system issues. Also seeing my two co-Investigators discuss the work they do in parallel to COHESION highlighted the quality of the individuals we have and how they truly are at the forefront of their fields. Hopefully, in the future, the COHESION team will be able to present its results in such a forum highlighting lessons learnt from NCDs and NTDs in improving PHC for other conditions.
Jaime Miranda, David Beran, Albertino Damasceno