OBESITY
Obesity is a well-known risk factor for cardiovascular disease, which affects both adults and children. According to the WHO, in 2005, 1.6 billion adults worldwide were overweight and 40 million adults were obese. Based on these numbers, the WHO predicts that by 2020, there will be 5 million deaths attributable to obesity each year.[22]  In developing countries,  being overweight historically has been viewed as a sign of wealth. With the global marketing of high-calorie, processed meals that are cheap and readily available, evidence shows that it is the underprivileged who tend to be overweight. Although this leads to populations having high rates of obesity and the attendant diseases that obesity creates, this cohort still has significant malnutrition because of the lack of access to nutritionally complete foods. Another factor contributing to the rise in obesity in developing countries is the shift to reduced physical activity in all aspects of daily life. With urbanization,  more people have desk jobs, use cars and buses for transportation, and participate in sedentary leisure activities such as watching television and movies. Therefore, the combination of less active lifestyles and the transition to high-fat, high-calorie diets has made obesity a prevailing public health problem internationally. Individual governments and health care leaders have the opportunity to educate the public. For example, Mexico has initiated major efforts to use the media and community-based programs to educate children and parents on healthy lifestyles.[11]

Several tangible public health measures implemented in the United States can be applied to the developing world. Companies are required by law to label their commercial foods with the ingredients as well as the caloric, fat, carbohydrate, and sodium contents. Certain municipalities have similar requirements for restaurants to label their foods as well and to encourage the offering of healthy menu options.

With the rise in childhood obesity, schools have made significant efforts to provide healthier lunches to students. Although not all of the measures are applicable in the developing world where poverty and limited resources are common, the same strategies can be used to implement mass media to educate the public on nutrition, exercise,  and risk factors for cardiovascular disease.  For example,  public service messages can be used to emphasize the rise in cardiovascular disease and associated risk factors. Another option would be to organize health fairs at which the public can be provided with education materials and pamphlets, as well as screening for chronic diseases such as hypertension and diabetes.

PHARMACOLOGIC THERAPY
Nearly half of the improvement in cardiovascular mortality in the United States is attributable to primary prevention of risk factors. The other half is due to secondary prevention after cardiovascular events.[23] For both targets of prevention, medications such as aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering medications are necessary;  yet,  especially worldwide,  these medications are not readily available to everyone.[24] Significant numbers of future cardiovascular events could be prevented with programs that provide affordable and accessible medications to those who need them. One proposed solution is the development of a polypill where different classes of medications are combined in one pill. A randomized controlled trial evaluating the efficacy of a polypill randomized 2,053 individuals in 50 centers across India to the five-in-one Polycap pill (thiazide, atenolol, ramipril, simvastatin, and aspirin) or to each of the drugs individually. The results showed that the Polycap was equivalent to the individual components in reducing blood pressure and heart rate, although the degree of low-density lipoprotein cholesterol reduction was less than that with simvastatin alone.[25] The concept of the polypill shows great promise as a convenient and potentially affordable way to bring primary cardiovascular prevention to large populations worldwide.

Governments can work with pharmaceutical companies to manufacture and provide cheap and generic drugs for the developing world. Currently, many medications to prevent and treat cardiovascular disease are not available in the developing world or are available at much higher costs. Some reasons for the greater expense of drugs in these countries include the lack of generic drug availability, and the expensive distribution networks through which intermediaries sequentially mark up prices.[26] Government legislation is needed to ensure drug quality, facilitate the availability and distribution of appropriate generic medications, and create financial systems, such as insurance plans, that will allow individuals to pay for medications.

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Helina Kassahun, MD, and William B. Borden, MD, MBA