The Commitment Of Cittadinanzattiva-Active Citizenship Network In The Prevention Of Cerebro And Cardiovascular Diseases

Cittadinanzattiva has more than 30 year experience in the protection of citizens' rights in the health sector, which initiated with its Tribunale per i diritti del malato ("Tribunal for Patients' Rights" or TDM) in 1980 and was later strengthened through the Coordinamento nazionale Associazioni Malati Cronici (National Coordination Centre of Chronic Patients' Associations) in 1996.
In spite of the fact that about 97% of health budgets are presently spent on treatment, whereas only 3% are invested in prevention (EU Commission 2013), we are convinced that prevention is imperative. CVDs are the number one cause of death globally: more people die annually from CVDs than from any other cause. The number of people who die from CVDs, mainly from heart disease and stroke, will increase to reach 23.3. million by 2030. CVDs are projected to remain the single leading cause of death. At a European level, the, the European Heart Network calculated that the cost for the treatment of cerebro and cardiovascular diseases is more than 196 billion euros each year.

To reduce the number of deaths due to cardiovascular diseases, European Member States found an agreement in 2013 with the Health for Growth - Proposal for the 3rd multi-annual programme 2014-2020. The aim is to identify, spread and promote the adoption of validated good practices for efficient and sustainable prevention measures, facing the main risk factors related to cardiovascular diseases, fighting tobacco use, alcohol dependence, obesity and promoting good lifestyles.

In this context, over the last 15 years, our organization has been increasing its contributions for the prevention of cardiovascular and cerebrovascular diseases through the following strategic actions:

1. Protection against violations of the right of individual citizens, through its free-of-charge counselling, information and support service provided by 300 TDM offices located nationwide.

2. Production of civic information
Since 17 years, we collect citizens’ concerns and warnings in the annual report about the Italian healthcare system produced by the National headquarter, local centers and Tribunal for patients’ rights offices of all over Italy. This report (so called Pit) wants to give a picture of the Italian healthcare seen from citizens’ point of view. In this context, citizens have underlined that the main issues concerning treatments and services related to cardio and cerebrovascular diseases are:

  • Too long waiting-lists for diagnosis exams (9.8% in the cardiology area, 24% in radiology, 17.5% in oncology and 13.6% in gynecology);
  • Waiting-lists for specialized examinations in the cardiology area (25% of the total; only ophthalmology comes first with 25, 6%);
  • Difficulties in local healthcare assistance;
  • Difficulties in hospitals, considering that 8% of citizens with neurological pathologies  and 7,6% of people suffering from cardiovascular diseases highlights premature releases and problems of taking care;
  • Difficulties in access to drugs (costs, bureaucratic and administrative barriers) and to therapeutic plan

Presented in March 2014 to the Italian Parliament by Cittadinanzattiva-Tribunal for patients’ rights 'Mi sta a cuore', done with the aim of analyzing the way in which some Italian regions and primary care centers are implementing the networks of prevention, treatment and taking care of patients with cardio and cerebrovascular diseases, shows the work of different Italian regions and primary care providers in order to monitor and improve prevention, treatment and care systems. The survey shows that when talking about prevention programs, emergency management, continuity of care for patients there is a very heterogeneous situation among the Italian regions. More specifically, prevention is really different considered especially related with  health lifestyle suggestions, tobacco use and excessive use of salt fight, physical exercise and young people education.

3.Participation in institutional working tables
In 2014 the Italian Minister of Health appointed Cittadinanzattiva in the committees that will elaborate the “National Plan of Chronicity” that will deal with cardio and cerebrovascular diseases.

4. Promotion of local initiatives to raise citizens’ awareness such as:
The initiative was organized in April 2014 in Recanati (Macerata) by Cittadinanzattiva of Porto Recanati Onlus and the Association of diabetic patients’ protection, the Association Camminiamo Insieme with the contribution of the city neighborhoods, Civil Protection and many other citizens’ associations. Lots were the participants, including children, who had fun with the heart-shaped red balloons. The walk finished in the main square of the city where a cardiologist explained what is the right lifestyle to have a healthy cardiovascular system for as long as possible, recommending to daily walk in order to keep in shape. 

5. Promotion of informative campaigns for citizens at national level, such as:
Stroke is one of the main causes of women and men death, and in many cases this pathology could have been prevented. For this reason, the Tribunal of Patients’ rights- Cittadinanzattiva launched a campaign for the prevention of cardiovascular risk named “Rincuorando”.
The campaign was designed for the citizens’ information, in particular:

  • Concerning the importance of a lifestyle that puts the attention on the control of risks factors such as tobacco use, hypertension, not balanced diet, absence of physical exercise;
  • Concerning the information about home/self-blood pressure monitors to be done by patients at home. Home blood pressure measurement has the advantage that BP recordings can be measured in different days and moments of daily life. It can be a real help for doctors to verify the efficiency of treatments;
  • Concerning the need of looking at this information as some kind of guidelines for the cardiovascular risk prevention;

This campaign for the prevention of cardiovascular risk was realized by Cittadinanzattiva-Tribunal of patients’ rights in collaboration with Fimmg-Federazione Nazionale Medici di Medicina Generale, Fondazione italiana per il cuore (National Federation of Physicians of General Medicine), Assofarm (federation that puts together 1600 public pharmacies) and in partnership with Ratiopharm.
The instruments used to raise the public awareness on primary and secondary prevention were:

  • a vademecum on right lifestyles for citizens with risk of cardiovascular diseases, with useful suggestions in order to control risk factors (diet, tobacco use, obesity, cholesterol, diabetes and menopause);
  • a “diary of pressure” to take note of the home/self-blood pressure measurement;
  • a cardiovascular risk sheet presented to citizens in form of questionnaire to be filled with the help of the family doctors to estimate the level of personal risk;  

All this was meant as an input to stimulate the personal reflection on risky behaviors (the vademecum), but also the debate with family doctors (the test elaborated on the model of cardiovascular risk charts) and the active participation to the management of the own conditions (the “diary of pressure” to take note of the home/self-blood pressure measurement).
These information instruments were widespread through the local network of Cittadinanzattiva (10.000 active citizens in hospitals and local services, organized in 300 Tribunal of patients’ rights local sections), 30,000 medical practices and 1,600 local pharmacies.
Pharmacies, hospitals, medical practices and local services were the places where citizens could learn about the initiatives of Rincuorando and have the materials dedicated to them. To propose and explain the initiatives and the materials were the same doctors, pharmacists or volunteers of Cittadinanzattiva-Tribunal of patients’ rights.
Together with the direct action of citizen, the project also included a working table with different subjects committed in the project concerning future initiatives with the same aim.

CARDIOLAB (ongoing from 2003)
Campaign entirely dedicated to develop initiatives to raise awareness of cardiovascular and cerebrovascular diseases, sponsored by Bayer, in which also participated Cittadinanzattiva, the Coordination of the Associations of patients with chronic diseases, ALT-Associazione per la lotta alla trombosi,  FAND-Federazione Associazione Nazionale Diabetici and Aid-Associazione Italiana Diabetici.
With the participation of physicians in medical practices and public squares of Italian cities, specialist in cardiology and volunteers of the Italian Red Cross, the aim of the pluriannual campaign was to calculate the global cardio and cerebrovascular risk of patients through the measurement of blood pressure, cholesterol and glycaemia. These free and open to everybody medical examinations were the instrument to inform and raise the awareness of people about the relevance of prevention of stroke and ictus, through anonymous questionnaires and epidemiological data to have a picture of the situation in different realities. The project, started in 2003, during the years reached more than 170 Italian cities for a total of 56.000 medical examinations.

“MI STA A CUORE” Awareness campaign (2014)
With the campaign Mi sta a cuore Cittadinanzattiva wants to make citizens aware of how to prevent cardio and cerebrovascular diseases and what are the treatments they have the right to access to.
The campaign, realized with the non-conditioned contribution of Bayer, want to raise citizens’ awareness of the importance of right healthy life styles and of the risks that can determine cardio and cerebrovascular diseases. With this aim an informative guide was created on the topic also thanks to the collaboration of Federfarma.
Since November 2014, the guide will be downloaded from the website and widespread by the Tribunal of patients’ rights offices and by the 20 public initiatives organized between November and December at a national level.
Promoting and wide spreading the knowledge of these topics through the pharmacies is an occasion to guarantee to citizens correct and specific information at national and local level. For this reason, Federfarma guaranteed the willing of pharmacies to actively participate to the promotion of this initiative, raising the awareness of citizens about the messages of this campaign, but also offering a free control of high, weight and blood pressure to people potentially risking cardiovascular diseases. To promote the initiative a roll-up was realized to be sent to pharmacies.

6. Participation in raising awareness campaigns and international networks:
Active Citizenship Network, Cittadinanzattiva European branch decided to be involved in this campaign and participates to the activities of STROKE ALLIANCE FOR EUROPE (SAFE), the European Alliance that deals with stroke and that represents patients at European level. The Alliance works with the double aim to drive stroke prevention up in the European political agenda and prevent the incidence of stroke through education.

It is a special Day organized for the first time in 2000 by the World Heart Federation. It takes place every last Sunday of September and it has the goal to raise the awareness of the importance of the prevention for the cardiovascular diseases. Every year the Day focuses on a specific aspect of the issue. Since many years
Cittadinanzattiva participates in the initiative with the goal of contributing to raise the awareness of public opinion and promote prevention measures to reduce the incidence of cardiovascular diseases and ictus all over the world. All this is important to put people in the condition of making conscious and right choices for their heart health wherever they live, work and play.  

(Update November 2014)

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