Prevention: The Ferrara Example
Roberto Ferrari
Introduction • In the last 30 years, life span has increased by 8 years
• Cardiology has contributed to at least 6 of these years
• CV death continues to be the number 1 killer worldwide
Introduction • We have only delayed CV
death and transformed an acute disease into a chronic one
• We should not drop our guard - and we will not
Treatment vs Prevention
• We are trained to treat • We have proven that we are able to do so
• Only recently we pay
attention to prevention
Treatment vs Prevention • Role of therapy (Asprin, ACE-
inhibitors, statins, β-blockers) is enormous.
• The more costly interventions
(although highly advocated by cardiologists) contribute little.
Treatment vs Prevention • Revascularisation explains 5% of the fall in CV death.
• It is applied too late or to too few and is too expensive
• Even doubling revascularisation would make little difference
Prevention vs Treatment
• Treatment accounts for
between 25-55% of the CV mortality decline
• Prevention could account for between 45-75%
Prevention vs Treatment
• Treatment rests in the
hands of cardiologists
• Prevention does not and should not
Which prevention strategy? 1 - A population strategy
• Paramount importance • Dealt with by doctors,
institutions, cities, nations, policy makers, politicians
Which prevention strategy? 2 – High risk strategy
• Important but limited for survivors
• Dealt with by cardiologists
What is prevention? • Awareness, behavior, laws, education, lifestyle, etc.
• Alteration of majority (if not all) aspects of the Western civilisation.
• Too important to be left to medical doctors alone.
Prevention and lifestyle
• Changing the lifestyle of a
population for the better is not an easy task
• Ironically it is easier to deteriorate it
Changing lifestyle • A battle against the negative subliminal messages from consumer society (movies, TV, internet).
• A challenge to important economic interests.
• Needs time
Walking the dog
Ferrara a city of prevention
Why Ferrara? • A city of 131.000 inhabitants • With more than 600 years of university culture
• With close links between different institutions
Why Ferrara? • 9 Km of medieval wall
Why Ferrara? • 9 Km of medieval wall • A city of bicycles
Why Ferrara? • 9 Km of medieval wall • A city of bicycles • Number 1 producer of fruit and vegetables in Italy
Why Ferrara? • 9 Km of medieval wall • A city of bicycles • Number 1 producer of fruit and vegetables in Italy
• Heavy fishing industry
Why Ferrara? • 9 Km of medieval wall • A city of bicycles • Number 1 producer of fruit and vegetables in Italy
• Heavy fishing industry • Only 1 cardiological department!
Ferrara: City of Prevention An integrated project with the:
• Italian Ministry of Health • Italian National Institute of Health • University and Hospital of Ferrara • Regional Health Government • Ferrara Municipality and District Councils
Ferrara: City of Prevention An integrated project with the:
• GVM Hospitals of Care and Research • Anna Maria Sechi Foundation • Various patient associations • Hospitality and catering industry • Fruit and vegetable industry • Fishing industry
Ferrara: City of Prevention An integrated project of:
• Surveillance of disease burden • Preventative action at population and individual levels
• Assessment of the efficacy
Ferrara: City of Prevention National TV
Several institutions
University & Industry School for prevention professionals
Food Industry
Ferrara: City of Prevention Dedicated health channel
Several institutions
University & Industry School for prevention professionals
Food Industry
Ferrara: City of Prevention Dedicated health channel
Several institutions
University & Industry School for prevention professionals
Production Of adequate food
Ferrara: City of Prevention Dedicated health channel
Several institutions
University & Industry To create a prevention professional
Production Of adequate food
Ferrara: City of Prevention Dedicated health channel
Awareness websites Books etc.
University & Industry To create a prevention professional
Production Of adequate food
Ferrara: City of Prevention • Creation of “home of prevention” strategically located – Palazzo Turchi di Bagni in front of the Palazzo dei Diamanti in the heart of the city
Ferrara: Home of prevention what is it? A place where:
•Citizens can assess their CV risk whenever they want
•CV patients can receive information on reducing their risk
Ferrara: Home of prevention what is it?
• ad hoc trained personnel (from the school) dedicate time to citizens to help them remain healthy and to provide suggestions to high risk patients.
Ferrara: Home of prevention what is it?
• A place to learn how to: stop smoking shop for appropriate ingredients prepare appropriate menus exercise
Ferrara: Home of prevention what is it?
• A place with an operative kitchen for proper cookery courses.
• A place where educational material can be found.
Ferrara: City of Prevention Global preventative action
• Website: “Cuore al Centro” • TV: 1 hour of weekly education at a national level.
• Constitution of a university
certified digital health channel
Ferrara: City of Prevention Global preventative action
• Preparation of frozen portions of adequate food
• Production of heart healthy bread and cakes
• Preparation of adequate frozen menus for hospitals
White, no salt, high omega3, fibres and‌ tasty!
Ferrara: City of Prevention Project assessment
• The concept will be exported to other countries.
• Data will be horizontally
collected yearly for at least 10 years and compared with the general population.
Conclusion • This is not the end. It is not even the
beginning of the end. But it is, perhaps, the end of the beginning…
• We hope in 10 years to: understand how and why people make the wrong decision regarding diet and lifestyle convince a city to have the courage to advocate policy changes for the better produce a model for CV prevention
End
Roberto Ferrari