Who are we?
LINKS is a collaborative effort of the World Health Organization, the U.S. Centers for Disease Control and Prevention through the CDC Foundation and Resolve to Save Lives, an initiative of Vital Strategies.
LINKS’ toolkit of technical resources is available to the public, but we encourage you to apply for a free LINKS membership which provides additional access to:
Participation in webinars
Opportunity to apply for technical assistance or one-time grant funding support to eligible programs. You can find more information below.
What is the basis for LINKS?
Why cardiovascular health?
Cardiovascular disease (CVD) is the world’s leading cause of death. Despite the availability of effective, inexpensive, and safe prevention and treatment, CVD accounts for one in three deaths and kills 18 million people each year globally. More than 75% of CVD deaths occur in low- or middle-income countries. In lower-income countries, CVD disproportionately affects people under 70.
While there is still much progress to be made, CVD deaths have decreased dramatically in higher-income countries. For example, improvements to prevention and treatment of hypertension have reduced related deaths in higher-income countries and accounted for 60% of the decline in CVD-related deaths in the USA between 1950 and 2000. Achieving similar declines worldwide would save millions of lives and reduce medical costs. Currently, less than 1% of the $35 billion spent each year on health assistance is for CVD prevention, yet the global health care savings from effective management of blood pressure alone have been estimated at $100 billion per year.
Why hypertension control?
High blood pressure kills more people than any other condition – approximately 10 million deaths per year can be attributed to hypertension, more than all infectious diseases combined. Reducing blood pressure prevents stroke, heart attack, kidney damage and other health problems.
Only 1 in 7 people with high blood pressure has it under control. An estimated 1.4 billion people worldwide have high blood pressure, but only approximately 200 million or 14% have it under control.
Blood pressure can be controlled. Health providers in high- and low-income countries, urban and rural areas, and across different health systems show it can be done. Canada has reached nearly 70% control nationwide, and Barbados and Malawi have shown it is possible to increase control rates rapidly.
Treatment is low-cost and simple. Existing health programs can achieve success by employing proven strategies to improve control of hypertension, including:
Practical treatment protocols with specific medications, dosages, and steps to take if blood pressure is not controlled.
Community-based care and task sharing so that health workers who are accessible to patients in their communities can provide, adjust and intensify medication regimens per physician orders and protocols.
Regular and uninterrupted supply of medications to get the right medicine to the right place at the right time to reach the patients who need them.
Patient-centered services that reduce the barriers to adherence, such as easy-to-take medicine regimens, free medications and follow up visits, and readily available blood pressure monitoring.
Information systems that allow continuous, real-time program improvement to determine how patients and providers are doing and catalyze rapid improvements.
Why salt reduction?
Excess salt increases blood pressure and risk of cardiovascular disease. Globally, excess salt consumption (>5.0g per day) is responsible for 1.65 million deaths from heart disease, stroke, and related causes each year. Four out of five of these deaths occur in low- and middle-income countries, and nearly half are among people younger than 70.
Average salt intake is nearly twice the recommended level. In 181 of 187 countries, estimated average levels of salt intake exceed the World Health Organization’s recommendation of 5.0g per day, or just under one teaspoon per day.
Salt intake can be reduced. Experience from the United Kingdom shows that with concerted and coordinated effort, food manufacturers can substantially reduce the salt content of food. These strategies were associated with a 15% decrease in salt consumption and a 40% decline in heart disease and stroke deaths in less than 10 years.
When food companies and restaurants reduce salt, they put choice into consumers’ hands. Once salt is in your food, you can’t take it out. Studies show that when consumers are offered lower-salt food, they only add a small fraction of the salt back at the table.
Reducing salt in food will save lives and money and can be accomplished through education and empowerment of consumers, collaboration with the food industry, and government guidance. Reducing salt is complementary to improving treatment of high blood pressure. Salt reduction lowers blood pressure and can reduce the number of people who need treatment.
Why elimination of artifical trans fat?
Artificial trans fat is a toxic chemical that increases the risk of heart attack and death. Globally, artificial trans fat intake is estimated to cause more than 500,000 deaths every year.
Artificial trans fat can be eliminated. Experience from food manufacturers shows that artificial trans fat can be eliminated (it may take 2-3 years for certain foods) and replaced with healthier alternatives without altering taste or increasing cost.
Elimination of artificial trans fat has substantial health benefits. Eliminating artificial trans fat from food in Denmark reduced deaths from cardiovascular disease. In New York State, people living in counties with artificial trans fat restrictions in restaurant food had a 6.2% greater decrease in hospital admissions from heart attacks and strokes than people in counties without restrictions.
Artificial trans fat can be eliminated through regulatory action and enforcement, but the sources of artificial trans fat globally are varied and there is currently no systematic effort to measure or eliminate its use. Supporting and working with local, national, and global governments to help scale up proven strategies, e.g., trans fat limits, restrictions and mandatory labeling, can help reduce and eliminate exposure to artificial trans fats and increase availability of healthier alternatives.
Types of support
LINKS members are eligible to apply on behalf of government and non-governmental organizations in low- and middle-income countries (LMICs) for limited technical assistance from a roster of global experts or one-time grants to catalyze or improve country progress toward improvement of cardiovascular health.
Technical assistance may be virtual or on-site. There is no deadline for applying for technical assistance; applications may be submitted at any time and will be reviewed on a case-by-case basis as they are received.
One-time grants are limited to a maximum value of $200K USD and a time-frame of up to two years. The current round for grant applications is now open; the deadline to apply is 15 June 2019. Recipients of the first round of LINKS one-time grant support were announced on 20 March 2019! You can read the press release here.
Register to become a LINKS member for additional information and gain access to the application documents.
Please feel free to contact the LINKS team with questions or suggestions at firstname.lastname@example.org
World Health Organization. Cardiovascular Diseases (CVDs) Fact Sheet. May 2017. Accessed on Jan 4, 2018 at http://www.who.int/mediacentre/factsheets/fs317/en/.
Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol. 2017;71:1‐25.
Frieden TR, Jaffe MG. Saving 100 million lives by improving global treatment of hypertension and reducing cardiovascular disease risk factors. J Clin Hypertens. 2018;20:208–211.
Centers for Disease Control and Prevention (CDC). Achievements in public health, 1900-1999:decline in deaths from heart disease and stroke – United States, 1900-1999. MMWR Morb Mortal Wkly Rep. 1999;48:649‐656.
Frieden TR, Bloomberg MR. Saving an additional 100 million lives. Lancet 2017; published online Sept 12. http://dx.doi.org/10.1016/S0140-6736(17)32443-1.
GBD 2013 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386:2287-2323.
Mills KT, Bundy JD, Kelly TN, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134(6):441-450.
Padwal RS, Bienek A, McAlister FA, Campbell NR; Outcomes Research Task Force of the Canadian Hypertension Education Program. Epidemiology of hypertension in Canada: an update. Can J Cardiol. 2016;32(5):687-694.
GSHTP Barbados Pilot Analysis Report, 2014-2016. Standardized Hypertension Treatment Project (SHTP). Healthy Caribbean Coalition, GSHTP Core Team and Professor Ian Hambleton, Chronic Disease Research Center. July 2016. For more information: HEARTS package. Geneva: World Health Organization; 2016. Accessed on 08 September at http://www.who.int/cardiovascular_diseases/hearts/en/.
Mozaffarian D, Fahimi S, Singh GM, et al. Global sodium consumption and death from cardiovascular causes. N Engl J Med. 2014 Aug 14;371(7):624-634.
He FJ, Pombo-Rodrigues S, Macgregor GA. Salt reduction in England from 2003 to 2011: its relationship to blood pressure, stroke and ischaemic heart disease mortality. BMJ Open. 2014;4(4):e004549.
Beauchamp G, Bertino M, Engelman K. Failure to Compensate Decreased Dietary Sodium With Increased Table Salt Usage. JAMA. 1987;258(22):3275-3278. For more information: SHAKE package. Geneva: World Health Organization; 2016. Accessed on 08 September, 2017 at http://www.who.int/dietphysicalactivity/publications/shake-salt-habit/en/.
Elimination of artificial trans fat
Wang Q, Afshin A, Yakoob MY, et al; Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE). Impact of nonoptimal intakes of saturated, polyunsaturated, and trans fat on global burdens of coronary heart disease. J Am Heart Assoc. 2016 Jan 20;5(1).
Angell SY, Cobb LK, Curtis CJ, Konty KJ, Silver LD. Change in trans fatty acid content of fast-food purchases associated with New York City’s restaurant regulation: a pre-post study. Ann Intern Med. 2012 Jul 17;157(2):81-86.
Restrepo BJ, Rieger M. Denmark’s policy on artificial trans fat and cardiovascular disease. Am J Prev Med. 2016 Jan;50(1):69-76. 4 Brandt EJ, Myerson R, Perraillon MC, Polonsky TS. Hospital admissions for myocardial infarction and stroke before and after the trans-fatty acid restrictions in New York. JAMA Cardiol. 2017 Jun 1;2(6):627-634