The World Health Report 2003 yet, as the chapter of this report on SARS has shown, cross-disciplinary collaboration is not only possible but can be enormously rewarding to all concerned. In the case of this new pidemic, the worlds best scientists, clinicians and public health experts were willing to se aside academic competition and work together for the public good- because the circum- stances so clearly required it. Paradoxically, a matching policy response to tackle public health challenges of even greater magnitude is lacking: the mounting menace of the global CVD epidemic is evolving rapidly Another critical policy issue, especially for poor countries, concerns the appropriate balance between primary and secondary prevention and between the population and high-risk ap- proaches to primary prevention. If the goal is to increase the proportion of the population at low risk and to ensure that all groups benefit, the strategy with the greatest potential is the one directed at the whole population, not just people with high levels of risk factors or estab- lished disease(5). All other strategies will, at best, only blunt the epidemics and likely in- crease inequalities; they will not prevent the epidemics. Even so, with ageing populations, health systems will continue to face the unrelenting demands of costly care, both acute and chronic(see Box 1.3 in Chapter 1) The ultimate public health policy goal is the reduction of population risk, and since most of the population in most countries is not at the optimal risk level, it follows that the majority of prevention and control resources should be directed towards this goal in the entire popula tion. Evidence is available in support of the cost-effective policies required for the task of making the small-but powerful and surprisingly rapid -shifts in risk distributions in entire populations in a favourable direction (1). Similarly, management decisions based on meas- ures of overall risk are more cost-effective than those based on single risk factors Untold lives lost are lost unnecessarily because of inadequate acute and long-term manage- ment of CVD. Relatively cheap interventions for CVD are available(6), and single combina tion pills including aspirin and drugs for blood pressure and cholesterol lowering for possible use in chronic care are under development. Even in wealthy countries, however, the potential of these and other interventions for secondary prevention is far from fully utilized. The situ ation in poorer countries is even less satisfactory. There are many opportunities for coordi- nated CVD risk reduction, care and long-term management. Smoking cessation and the identification and management of diabetes, for example, are just two priorities. Cost-effec tive interventions, such as the use of aspirin in people with symptoms of chest pain, would prevent a quarter of the deaths associated with heart attacks and are much more cost-effe tive than more radical interventions such as revascularization procedures, which are inevita bly restricted to a minority of patients with CVD. Acting now and measuring progress There have been striking and rapid reductions in Cvd death rates in wealthy countries especially benefiting the wealthiest and most educated -because of comprehensive approaches including both improved prevention and the management of high-risk people. Policy inter ventions in developed and developing countries can lead to a surprisingly rapid response. In Mauritius, government action to encourage consumption of healthy oils resulted in a rapid decrease in population levels of blood cholesterol In Finland, government agricultural sub sidies were used to reduce dairy farming and increase berry production. And in Poland, in- creased consumption of fresh fruit and vegetables, consequent to changes in the polio environment, were associated with a sharp decline in CVD death rates. A WHO/FAO expert onsultation report on diet, nutrition and the prevention of chronic diseases reviewed the88 The World Health Report 2003 yet, as the chapter of this report on SARS has shown, cross-disciplinary collaboration is not only possible but can be enormously rewarding to all concerned. In the case of this new epidemic, the world’s best scientists, clinicians and public health experts were willing to set aside academic competition and work together for the public good – because the circum￾stances so clearly required it. Paradoxically, a matching policy response to tackle public health challenges of even greater magnitude is lacking: the mounting menace of the global CVD epidemic is evolving rapidly. Another critical policy issue, especially for poor countries, concerns the appropriate balance between primary and secondary prevention and between the population and high-risk ap￾proaches to primary prevention. If the goal is to increase the proportion of the population at low risk and to ensure that all groups benefit, the strategy with the greatest potential is the one directed at the whole population, not just people with high levels of risk factors or estab￾lished disease (5). All other strategies will, at best, only blunt the epidemics and likely in￾crease inequalities; they will not prevent the epidemics. Even so, with ageing populations, health systems will continue to face the unrelenting demands of costly care, both acute and chronic (see Box 1.3 in Chapter 1). The ultimate public health policy goal is the reduction of population risk, and since most of the population in most countries is not at the optimal risk level, it follows that the majority of prevention and control resources should be directed towards this goal in the entire popula￾tion. Evidence is available in support of the cost-effective policies required for the task of making the small – but powerful and surprisingly rapid – shifts in risk distributions in entire populations in a favourable direction (1). Similarly, management decisions based on meas￾ures of overall risk are more cost-effective than those based on single risk factors. Untold lives lost are lost unnecessarily because of inadequate acute and long-term manage￾ment of CVD. Relatively cheap interventions for CVD are available (6), and single combina￾tion pills including aspirin and drugs for blood pressure and cholesterol lowering for possible use in chronic care are under development. Even in wealthy countries, however, the potential of these and other interventions for secondary prevention is far from fully utilized. The situ￾ation in poorer countries is even less satisfactory. There are many opportunities for coordi￾nated CVD risk reduction, care and long-term management. Smoking cessation and the identification and management of diabetes, for example, are just two priorities. Cost-effec￾tive interventions, such as the use of aspirin in people with symptoms of chest pain, would prevent a quarter of the deaths associated with heart attacks and are much more cost-effec￾tive than more radical interventions such as revascularization procedures, which are inevita￾bly restricted to a minority of patients with CVD. Acting now and measuring progress There have been striking and rapid reductions in CVD death rates in wealthy countries – especially benefiting the wealthiest and most educated – because of comprehensive approaches including both improved prevention and the management of high-risk people. Policy inter￾ventions in developed and developing countries can lead to a surprisingly rapid response. In Mauritius, government action to encourage consumption of healthy oils resulted in a rapid decrease in population levels of blood cholesterol. In Finland, government agricultural sub￾sidies were used to reduce dairy farming and increase berry production. And in Poland, in￾creased consumption of fresh fruit and vegetables, consequent to changes in the policy environment, were associated with a sharp decline in CVD death rates. A WHO/FAO expert consultation report on diet, nutrition and the prevention of chronic diseases reviewed the