Circulatory health interventions and UHC benefit packages.

The WHO “Principles of Health Benefits Packages (HBP)” provides a useful framework for countries to decide what services should be included in HBP. It further details criteria to support decision-making on HBPs, including burden of disease, availability of cost-effective interventions, financial risk protection and the social and economic impact. When considering the burden of disease criteria, defined by morbidity, mortality and disability, circulatory diseases are the number one cause of death and disability worldwide, they contribute to more than 374 million of lives lost each year. People living with diabetes are two to four times more likely to die from heart disease and CVD is the leading cause of death for people with kidney disease. Moreover, due to their chronic nature and high cost of specialized care often needed to manage them, circulatory diseases contribute significantly to driving individuals and households into poverty when they need to pay for such services out of pocket. In some cases, individuals borrow money to be able to pay for the health services they need, while in other circumstances they avoid seeking care due to their inability to pay, raising questions of equity in access to health services. Financial risk protection againstcatastrophic health expenses due to circulatory diseases represents a prominent criterion in the decision-making process over HBPs. In this context, decision-makers should consider the impact on equity and prioritize financial risk protection for those with circulatory health conditions. In the recent WHO Global action plan 2013-2030 Appendix 3 and WHO Package of essential NCDinterventions, emphasis has been placed on the importance of scaling up early detection using multitargeted screening for elevated BP, blood glucose, cholesterol (by dipstick) and BMI; educational programs for lifestyle changes (including smokingcessation), with priority given to cost-effectiveintervention to control behavioural risk factors; expanding the use of digital technologies to increase health service access and efficacy for NCD prevention; reducing the costs in health care delivery, and a list of essential drugs and tools for free use. Therefore, evidence-informed polypill and digital technologies (such as the free Stroke Riskometer app or MyCKDCPGapp) for prevention of circulatory disorders should be used widely and added to the existing WHO list of Core Medicines and Essential Tools, respectively. Based on the totality of evidence, a tripartite approach to circulatory disorders prevention, comprising behavioural, pharmacological and structural interventions, is recommended. Such strategies and interventions should be included in the Universal Health Coverage-Priority Benefits Package (UHCPBP) because they are evidence-informed, account for economic realities and social preferences, ensure equity in access to preventative tools across all populations/countries, and allow the reduction of the burden of not only CVDs/stroke but also other circulatory and major NCDs with common riskfactors, such as dementia, diabetes mellitus, chronic obstructive pulmonary disease, all types of cancer, deep vein thrombosis, pulmonary embolism, chronickidney disease etc. By accepting these additional approaches for enhancing circulatory disease prevention at primary care level, WHO Member States can immediately take necessary concrete steps for improving global circulatory health and reducing the burden of these disorders in the world.