EDITORIAL
Mailing address
Key words: Men's health; population; Brazil; Brazilian Society of Cardiology.
The comprehension of the mechanisms of disease has led Medicine to intensely develop new therapeutic strategies in the last decades, strategies based mainly on intervention. However, these indisputable achievements in mortality and quality of life have not promoted the cure or complete remission of the disease symptoms and have been accompanied by a significant increase in healthcare costs that affect even the wealthier countries. These questions are setting the Medicine of the XXI century in motion toward the search for a new strategy to face Man's sickness and again have as the main focus the prevention of diseases, instead of waiting for the diseases to appear and treat them after they have set in. This path is becoming irreversible, as demonstrated by a lecture given by Professor Eugene Braunwald, at the last European Congress of Cardiology in the city of Barcelona, Spain. Dr. Braunwald participated in the symposium "Future of Cardiology as a Medical Specialty" and presented the lecture "Cardiology as a Profession in 2020 and beyond" and focused his presentation on the aspects of prevention as the best way to approach cardiovascular disease and the cardiologists' high priority in the next century.
The concept of prevention is not new and it is currently being used in our country. The Ministry and State Secretaries of Health have already developed several programs of health promotion that currently reach children and adolescents, women and the elderly. However, some questions have arisen: for which diseases should prevention be prioritized and which population should be the focus?
Brazil is rapidly going through a demographic transition, in which the mean age of the population is older. In 2000, approximately 15% of the population (27 million people) was 50 years or older. This percentage should increase to 42% (96 million people) in 2050. The mean age of the Brazilian individual, which in 2000 was 26 years, will be 44 years in 2050. As the population ages, the non-transmissible diseases will result in a burden to the Public Health System, considering that the cost of these diseases already represents half the costs of all hospital admissions in Brazil. These diseases are already responsible for a large and increasing part of the disease burden in Brazil, reaching a percentage of 66%, compared to 24% of transmissible diseases and 10% of wounds. The change in this profile, with a higher burden of non-transmissible diseases is due to the urbanization, improvement in healthcare quality, changes in life style, specific policies and globalization itself, expanding and disseminating technical-scientific knowledge. This burden of non-transmissible diseases is not necessarily an inevitable result of a modern society, but of a harm that can be prevented. For most of these diseases (coronary diseases, strokes, diabetes and several types of cancer), the main cause is not found in genetics, but in modifiable environmental and behavioral risk factors.
Among the non-transmissible diseases, the main focus is on the cardiovascular diseases, due to their current morbimortality rate as well as the somber perspectives for the following years.
The World Health Organization, in a study that projects a worldwide increase in the morbimortality of cardiovascular diseases, having as basis for this analysis the year 2040, elevates us to the tragic condition of world champions, by estimating that Brazil will reach an incremental rate of 250% when compared to China (200%) and India (180%)1. About this aspect, Lotufo's observation deserves attention, that an epidemics of cardiovascular disease (CVD) is about to be installed in our country, mainly due to the higher incidence of diabetes and obesity2.
The experience of the United States of America (USA) can be used as a starting point for the necessary changes in the public health system of our country. The USA presented a 51% decrease in the incidence of CVD among women and a 49% decrease among men, between the years of 1980 and 2000. And the fight against smoking and sedentary life style alone resulted in a 12% and 5% decrease in CVD rates, respectively3.
Another relevant aspect is the existence of health characteristics that are different between the sexes, according to data indicative of population health. In Brazil, in the year 2001, the women presented an 8-fold higher life expectancy when compared to men (73 x 65 years, respectively) and in the southeast region, this difference was of 12 years4,5. In Brazil, male mortality is practically higher at all age ranges, although the incidence of health complaints and the presence in outpatient clinics is predominantly female6. This information, instead of demonstrating a higher morbidity among women, may be due to a higher concern of the female sex with healthcare attention and might be the result of specific policies directly exclusively at the woman's health. Another interesting information concerns the age, considering that the latter is directly related to cardiovascular morbimortality. In Brazil, however, it is estimated that 40% of all deaths by CVD are situated in the age range < 65 years and also that the disease is affecting younger individuals, with 26.8% of cardiovascular deaths occurring in individuals aged 25 to 59 years.
National Policy of Primary Attention to Men's Health
All these data on CVD, demonstrating that it affects more men than women, the current prevalence and increase estimates in a near future, including the epidemics aspects, together with the disabling characteristics at a productive age, in addition to the fact that men do not prioritize their own health care, justified the creation of a Health Program specific for the male sex, similar to the healthcare programs directed at children, adolescents, women and the elderly. For that purpose, the Brazilian Society of Cardiology (SBC) had already developed, among its activities, programs of continuing education in preventive, therapeutic and rehabilitation measures that can be shared and multiplied at national level together with other medical specialties, seeking an impact on the variables that affect the men's health.
Invited by the Ministry of Health, the SBC participated in meetings on the implementation of a health policy directed at men's health, proposing a concrete and objective basis for the implementation of this policy regarding its cardiovascular aspect, recommending as the focus of the action four chapters of cardiovascular etiopathogeny that must be approached as a first strategy: risk factors; coronariopathies; arterial hypertension; rheumatic fever and myocardiopathies.
As the result of this effort, the Ministry of Health, through the Secretary of Healthcare Attention and Department of Strategic Programmatic Actions, with the support of several medical societies, including the Brazilian Society of Cardiology, implemented in August of 2008 the National Policy of Primary Attention to Men's Health. This policy has the objective of promoting the health and decreasing the premature death of male individuals due to cardiovascular, urologic, oncologic and psychiatric diseases7.
The Brazilian Society of Cardiology is confident that the development of this program, through the joint efforts of different medical societies, the Government and society, will result in a higher social insertion in healthcare, positively influencing the quality of life of the Brazilian men.
References
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1The challenge of cardiovascular diseases in developing economies. [Acessed in 2008 Feb 10]. Available from: http://www.earth.columbia.edu/news/2004
- 2. Lotufo PA. Increasing obesity in Brazil: predicting a new peak of cardiovascular mortality. São Paulo Medical J. 2000; 118 (6): 161-2.
- 3. Ford ES, Ajani UA, Croft J, Critchley JA, Labarthe DR, Kottke TE, et al. Explaining the decrease in U.S.: deaths from coronary disease, 1980-2000. N Engl J Med. 2007; 356: 2388-98.
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4OPS. Situacion de la saúde em lãs Américas Indicadores e dados básicos. (OPS/AIS/03.01).
- 5. Laurenti R, Jorge MHPM, Gotlieb SLD. Perfil epidemiológico da morbi-mortalidade masculina. Ciênc. saúde coletiva. 2005; 10 (1): 35-46.
- 6. César CLG, Figueiredo GM, Westphal MF, Cardoso MR, Costa MZA, Gattás VL. Morbidade referida a utilização de serviços de saúde em localidades urbanas brasileiras: metodologia. Rev Saúde Pública. 1996; 30 (2): 153-60.
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7Ministério da Saúde. Secretaria de Atenção a Saúde. Política nacional de atenção integral à saúde do homem. Brasília; 2008.
Cardiovascular health of the brazilian male - the view of the Brazilian Society of Cardiology
Publication Dates
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Publication in this collection
05 May 2010 -
Date of issue
Dec 2009
