Prevention of cardiovascular and metabolic diseases
The phrase 'prevention is better than cure' was coined by the Dutch philosopher Erasmus in around 1500. The case for prevention remains strong. As a result of demographic change and better healthcare more people live longer with one or multiple long-term conditions. The management of long-term conditions, in particular cardiovascular and metabolic conditions is expensive and threatens the sustainability of health care systems. The main preventable causes of morbidity and mortality are environmental and behavioural. External conditions such as the ‘obesogenic environment’, increasing socio-economic inequalities and climate and environmental risk factors contribute to health risk. Behavioural risk factors such as tobacco smoking, poor diet and physical inactivity, and misuse of alcohol have been identified as main causes of preventable mortality.
This research programme for prevention at the Mannheim Medical Faculty of Heidelberg University has three pillars. These pillars aim to improve population health and prevention science.
The vision for this division is based on a whole systems approach to prevention. We will focus on designing, building and evaluating the “bridges” that link insights from speciality driven research to real prevention successes, manifesting as maximizing reach and effectiveness in the target populations. Thus, the research will be future-focused, addressing developments in demographics, digital provision and inclusion (both in health and beyond) and lived environments of populations. Through three interlinked programmes, Personalised Prevention, Implementation of Evidence and Complex Interventions our division works on developing the evidence base for transformative interventions and advance the science of prevention. There will be a close correspondence between research and teaching enabling future prevention experts to deliver evidence-based prevention in a whole systems approach.
What We Do: Pillars of Research
1. Precision Prevention
Recent developments in science and technology allow for the development of interventions more individually tailored. However, there are substantial scientific challenges for precision prevention, in particular from a behavioural science perspective. For example, uptake of screening programmes is often low, particularly in groups at higher risk. Interventions involving medication adherence or behaviour change have often limited effectiveness, even if based on personalised risk feedback. In the early stages of the innovation circle we need to consider aspects of reach, efficacy, adoption, implementation and maintenance. Doing this will increase translational potential for precision public health approaches and offers opportunities to develop excellent prevention science.
2. Implementation of evidence in policy and practice
Much of the evidence of what would work to improve cardiovascular and metabolic health of the population is available. However, there is a substantial implementation gap in both health services and policy. For example, Germany is the last of 36 countries in implementing evidence-based tobacco control measures. Likewise, in diabetes prevention and management and in the management of cardiovascular risk factors there is potential for a step change in prevention in Germany. Implementing evidence-based prevention has the potential to improve population health and population health science.
3. Developing interventions to address syndemic risk in the population laboratory
Many of the behavioural and environmental risk factors for cardiovascular and metabolic risk are also risk factors for cancer, depression and other adverse health outcomes. They often cluster in social groups and geographies. Innovative approaches to develop and evaluate place-based interventions offer the potential of scientific excellence in prevention with demonstrated local impact and the potential for widespread application. Our methodological and applied work on intervention development offers substantial potential for creating innovative interventions in context and in collaboration with key stakeholders and end users.