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The Healthy Start for Young Hearts Alliance brings together experts across public health and clinical care with the aim to prevent cardiovascular disease before it begins.
Traditionally, cardiovascular disease (CVD) has been viewed as a condition of old age. However, recent evidence shows that targeting modifiable risk factors in childhood could prevent 30% of adult CVD, or even more. From a clinical and public health perspective, this is especially relevant in Australia, where unfavourable cardiovascular risk factors among children are both common and increasing. For example, the latest data from the Australian Institute of Health and Welfare show that 26% of children and adolescents aged two to 14 years were living with overweight/obesity in 2022 . This is expected to rise to 50% by 2050, representing an increase of 146% between 1990 and 2050. Fewer than one in 10 (8.5%) children and adolescents aged two to 17 years old ate the recommended amount of fruit and vegetables in 2020-2021 and approximately only 20% of children aged five to 18 years old met current physical activity recommendations in 2022.
Given the multi-level determinants of CVD, substantial multi-pronged actions are needed to turn the tide, including targeting policy levers, commercial and environmental determinants of health, school- and family-based approaches, as well as traditional primary and secondary prevention in a healthcare setting. In traditional healthcare approaches, barriers exist to influencing risk factors at the individual level. For example, Australian general practitioners have not been appropriately supported to deliver preventative healthcare activities including nutrition and physical activity, and they report low self-efficacy in working with patients to implement weight management and lifestyle changes.
Furthermore, despite Australia’s past successes in population-level risk-factor reduction programmes, adoption and implementation of recommendations in the more recent National Preventative Health Strategy and National Strategy for Obesity Prevention have been underwhelming. Of course, attaining a sustainable change in health-related behaviour is difficult. There is a complex interaction of individual (genetic predisposition and self-efficacy), social (education, low health literacy, employment, housing), environmental (inequitable access to health services, urbanisation without adequate active transport infrastructure, promotion of unhealthy behaviors, and lack of enabling policies) and commercial barriers (highly processed food system, promotion of tobacco and alcohol consumption) at play.
Intervention in adulthood: too little, too late
Although various preventative strategies in adults have contributed to declines in CVD-related deaths across the globe (which have now stalled), even optimal primary prevention implementation in those with adverse risk factors will not eliminate CVD altogether. For example, the lifetime risk of a major atherosclerotic cardiovascular event is approximately 30% for those who have one risk factor (ie, elevated BMI, blood pressure, current smoking) at the suboptimal level, or 70% for those who have two or more. On the other hand, the lifetime risk for those who maintain optimal risk factor levels into mid-life is less than 8%. Furthermore, improving elevated cardiovascular risk factors does not provide the same low level of risk as maintaining optimal levels from childhood. For example, in relation to blood pressure management, those who are treated to optimal levels have lower risk of CVD compared to those with uncontrolled blood pressure, but double the risk of those who have always had blood pressure levels at the optimal level.
These data by no means negate the need for primary prevention, but they do highlight that in terms of CVD risk reduction, mitigation of previously high-risk factor levels is not as successful as long-term maintenance of low risk levels from childhood.
Alongside treating those with existing risk factors, we must also work towards preventing the risk from developing in the first place. Although this has long been recognized as critical in the health promotion field, primordial prevention for CVD is rarely acknowledged across all sectors by external agencies (such as peak cardiovascular bodies, government and funders).
The recently released Heart Foundation Strategic Plan has a goal to (among others) “Collaborate across sectors to raise awareness of and improve the heart health in young people”. This represents a positive step forward, but Australia currently lacks national coordination and positive action for CVD prevention, commencing in childhood. Tellingly, whilst total spending on CVD in Australia amounts to nearly $17 billion annually, less than 2% of Australia’s healthcare spending goes toward prevention and only a small fraction of that is childhood-focused.
The Healthy Start for Young Hearts Alliance
Recognising the above complexities, the Healthy Start for Young Hearts Alliance has been established to drive a paradigm shift in Australia’s approach to CVD prevention. The Alliance brings together expertise across public health and clinical care, with a core goal of preventing CVD beginning in childhood. Rather than relying on isolated interventions, the Alliance advocates for a coordinated, multi-pronged strategy. This includes addressing environmental and behavioural drivers of risk, co-designing solutions with communities, translating evidence into policy and services and embedding preventive clinical pathways for children at elevated risk.
Reversing the current trends of CVD in Australia will require bold, system-level change. No single sector can achieve this alone. Success depends on collaboration among researchers, clinicians, implementation scientists, economists, policymakers, funders and communities themselves. Without decisive action, today’s children risk becoming tomorrow’s wave of chronic disease. But with early, coordinated prevention, we have an opportunity to reshape cardiovascular health for future generations.
Dr Rachel Climie is an NHMRC Emerging Leader Fellow and Heart Foundation Future Leader Fellow at Menzies Institute For Medical Research at the University of Tasmania. She leads a research team focused on the cardiovascular health of young people.
Jonathan Mynard is a Senior Research Fellow at the Murdoch Children’s Research Institute and Honorary Principal Fellow with the Department of Paediatrics at the University of Melbourne.
Sherly Li is paediatric dietitian/nutritional epidemiologist at Murdoch Children’s Research Institute.
Terry Dwyer is a Principal Fellow at Murdoch Children’s Research Institute. He is internationally recognised for his expertise in paediatric cohort studies investigating how early-life environmental and lifestyle factors influence disease outcomes.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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