Embedding equity and diversity principles in a complex multi-national setting: methods, tools, capacity development and experiences from the first year of the Joint Action on Cardiovascular Diseases and Diabetes (JACARDI)

Scientific publications by JACARDI  

In this post series we share the scientific publications directly linked to the JACARDI project. All publications featured in this series are authored or co-authored by JACARDI partners and reflect research and findings developed within the project framework.  

We aim to showcase how evidence supports our joint mission to tackle cardiovascular diseases and diabetes across Europe. 

Stay informed on how JACARDI turns evidence into action. 

Authors:  Natalia Skogberg, Teresa Spadea, Benedetta Armocida, Jelka Zaletel, Beatrice Formenti, Ane Fullaondo, Yhasmine Hamu, Maria Nousiainen, Sinikka Kytö, Laura Musta, Chiara Di Girolamo, Janne Sorensen, Idil Hussein, Graziano Onder, and Richard Osborne

Keywords: equity, diversity, inclusion, public health, capacity development, implementation, JACARDI

Abstract:

Effective reduction of social inequities in health requires acknowledgement of the deeply embedded intersectional nature of systemic drivers of these inequities. With increasing population cultural and ethnic diversity, it is essential to embed principles of equity, diversity, and inclusion from the outset of programs and policy development. This is likely to reduce the need for more costly corrective measures. While application of these principles does not necessarily require substantial additional resources, a structured and systematic approach is crucial for initiating a paradigm shift. It also requires deliberate efforts, practical tools, and capacity development to ensure embedding and uptake of these principles. The unprecedently large European Union (EU) co-funded Joint Action on Cardiovascular Diseases and Diabetes (JACARDI) involving 21 countries, 76 partners and 142 pilot projects, cross-cuttingly and systematically embeds equity, diversity, and inclusion principles in all its structures. JACARDI serves as a unique platform for development, introduction, and evaluation of methods and tools for embedding equity, diversity, and inclusivity principles in a complex and multidimensional real-life setting. This practice paper outlines the design and experiences from the first year of the JACARDI project applying the Normalisation Process Theory (NPT) for describing the developed methods, including the 4Cs framework (Critical reflection; Context and data; Co-design; and inclusive and accessible Communications), an equity and diversity maturity matrix, and capacity development. Key success factors and challenges are also discussed. Developed novel methods and tools aim to be transferable and scalable, thus contributing to more effective, sustainable, and inclusive public health policy and practice.

Source: BMJ Global Health, Volume 10, Issue 11

Prevention in Action: Combating Non-Communicable Diseases Through Collective Health Action and Education

The Prevention in Action (PIA) project was launched to address the fact that cardiovascular diseases and diabetes are recognized as among the world’s deadliest, yet most preventable, health threats. The core focus is the prevention of non-communicable diseases (NCDs).

PIA is a cross-border initiative aimed at preventing NCDs through a strategy involving education, early detection, and equitable access to health information. Its mission is to reduce the impact of NCDs by promoting healthy behaviours and empowering communities. The partners characterize PIA as more than a project, it’s a commitment to a healthier future.

The project runs for two years, from December 2023 to November 2025 and is led by a strong partnership between multiple Red Cross National Societies, including the Portuguese Red Cross, Hungarian Red Cross, Spanish Red Cross, Slovenian Red Cross, and Italian Red Cross. Through this collaboration, the National Societies support national and EU health policies and contribute to the UN 2030 Sustainable Development Goals.

The project specifically targets youth and people in vulnerable situations. Key beneficiaries include displaced individuals from Ukraine. 

PIA is projected to reach:

• close to 15,000 children and youth;
• 100 Red Cross staff and volunteers;
• 100 vulnerable individuals receiving health promotion services.

PIA delivers educational activities in various community settings:

• A Sudden Death Prevention Program is provided in schools and youth settings.
• This program teaches children and teachers about the risk factors and early signs of cardiovascular diseases and diabetes.
• Training is provided to help communities respond effectively in emergencies, such as CPR training for young people.

The project is developing a mobile application and remote monitoring tool intended to support individuals in managing their health proactively.

To ensure inclusivity, PIA develops culturally sensitive materials for vulnerable populations. These materials are made available at Red Cross health centres and are paired with enhanced screening and counselling during medical visits.

The activities undertaken by the PIA project help communities achieve essential outcomes, including:

• recognizing warning signs early;
• reducing risky behaviours;
• responding effectively in emergencies, for example, through CPR training for young people. 

To amplify the project’s impact, the PIA team actively aligns its actions with commemorative health dates, such as World Bicycle Day, World Health Day, or World First Aid Day. These dates provide powerful opportunities to raise awareness, engage the public, and promote prevention messages to broader audiences.

The project’s strategy ensures that prevention does not happen in the shadows, but instead becomes part of a shared public conversation about health and solidarity.

By investing in education, partnering across borders, and making prevention accessible to all, the PIA partners are setting an example of what collective health action can achieve.

Stay tuned for updates, tools, and events by visiting the project’s website, LinkedIn, Instagram, Facebook page, X and YouTube channel.

Healthy habits through storytelling: PODiaCar’s mission to reach 25,000 children

PODiaCar (Pediatric Health Through Prevention, Education, and Innovation) is an action grant created to address childhood obesity, which is identified as one of the most pressing public health concerns of our time. Childhood obesity carries long-term consequences that can lead to chronic conditions, including type 2 diabetes (T2D) and cardiovascular disease (CVD).

The project combines medical innovation with educational awareness. PODiaCar’s mission is twofold:

1. Promote early detection of risk factors for obesity-related diseases (T2D and CVD) using predictive tools and digital modeling to predict future health outcomes.
2. Raise awareness and foster healthy behaviors among children and families through engaging and accessible communication strategies.

The project is grounded not only in scientific rigor but also on the conviction that education and early awareness are essential for long-lasting impact.

PODiaCar was launched in late 2023 and is coordinated by the Buzzi Children’s Hospital – ASST Fatebenefratelli-Sacco in Milan. It involves a multidisciplinary team with partners from across Europe, specifically including organizations from:

• Italy (University of Pavia, Pavia)
• Spain (University of Granada)
• Malta (Asomi College of Science, Pembroke)
• Luxembourg (University of Applied Sciences, Differdange)

The project places children’s health at the center of community-led change and specifically targets children and families. By the end of the project, PODiaCar aims to reach over 25,000 children directly through its campaigns and educational activities.

The project’s educational campaign has been launched in kindergartens and primary schools across several European countries. Activities use interactive materials, storytelling, and classroom engagement to promote healthy habits in everyday learning environments.

The team is actively engaged in technical and clinical work, including the development of advanced digital tools:

• Advanced Screening Tool: This tool integrates clinical, nutritional, and behavioral data to identify children at risk of developing T2D and CVD.
• Personalized Digital Twin: This virtual model will help simulate and track a child’s health pathway over time, offering tailored recommendations and monitoring tools.

One of the first major successes was the creation of an animated cartoon designed to teach young children about healthy eating, physical activity, and overall wellbeing. The animated cartoon translates scientific concepts into playful, engaging messages that children can easily understand and enjoy.

The project also participated in the Trofei di Milano Cortina, a major sporting event linked to the Olympic games, providing a valuable opportunity to reach children and families in a dynamic, real-world setting.

Since its launch, PODiaCar has made significant steps toward its ambitious goals. The initial achievements include the creation and launch of the animated cartoon and the rollout of the educational campaign in kindergartens and primary schools. The development of the advanced screening tool and the Digital Twin is currently progressing.

The project’s evaluation methodology relies on the use of predictive tools and digital modelling. The personalized Digital Twin will function as a monitoring tool, helping to simulate and track a child’s health pathway over time.

The PODiaCar team warmly invites stakeholders across Europe to join the project’s mission to improve pediatric health through prevention, education, and innovation. The overall goal is to empower the next generation to grow up healthy, informed, and confident in their ability to take care of their own wellbeing.

For more information, visit the official website of the project. The project’s news can also be followed on Instagram.

Small lifestyle changes, big difference: PREACT shows the way

The PREACT (Prophylactic Education & Actions for Cardiovascular Diseases and Diabetes) project is an initiative that aims to prevent and reduce cardiometabolic risk, focusing primarily on cardiovascular diseases (CVD) and diabetes. These conditions are identified as leading causes of illness and death across Europe.

PREACT responds to this challenge with a strong focus on prevention over treatment. The core mission is achieved through early intervention, education, and behavior change. The project employs a collaborative, evidence-based, and community-driven approach to promote long-term health and well-being.

“PREACT is more than a project, it’s a mission to turn health awareness into daily action.” – said Pr. Evgenia Vlachou, a diabetes researcher. It launched in November 2023 and is scheduled to run through October 2026, spanning a total of 36 months.

A consortium was formed at inception, comprising diverse entities,bringing together academic institutions, healthcare professionals, public authorities, and civil society from across the EU. The project held its Kick-off Meeting in Athens in January 2024, which included 18 representatives from all partner organizations to align the vision, define roles, and finalize the strategic framework. The presence of the European Commission’s project officer during this meeting ensured compliance with EU standards.

Activities take place through pilot projects in schools, health institutions, and community settings across partner countries, reaching a diverse audience of community members, students, and institutional staff.

PREACT’s educational strategy includes several key development and training activities:

• The project held a joint staff training event in Komotini in June 2024.
• The event aimed to build a shared pedagogical foundation among trainers and co-develop culturally and linguistically tailored educational content.
• The educational toolkit and intervention materials were finalized and refined between July and October 2024, resulting in a comprehensive set of learner and facilitator resources.

Key milestones and phases of the project include:

1. Kick-off Meeting held in Athens in January 2024.
2. A comprehensive needs analysis undertaken from February to May 2024, focusing on modifiable risk factors like smoking, diet, physical inactivity, and caffeine consumption, particularly in the Greek and broader European context.
3. The joint staff training event held in Komotini in June 2024.
4. Launching  ten pilot actions starting in November 2024 and running through June 2025 in schools, health institutions, and community settings to test the materials’ real-world applicability and impact.

The needs analysis findings directly informed the design of PREACT’s educational materials. The project has finalized an educational toolkit and intervention materials.

In its first 18 months, PREACT successfully established a strong collaborative foundation and completed the initial research and preparation phases.

The success is attributed to the strong collaboration and real-world insights shared by diverse partners, including researchers, health professionals, and community educators.

• Prof. K. Papadimitriou, a trainer, commented that “small lifestyle changes can make a big difference. PREACT equips us to inspire those changes in practical, culturally relevant ways”.
• Olga R. from NGO OPORA noted that the Komotini training helped the team “build tools shaped by the people they’re meant to serve”.

The pilot actions, running from November 2024 to June 2025, were designed to test the real-world applicability and impact of the PREACT materials.

PREACT encourages engagement from various stakeholders, including health professionals, educators, policymakers, or anyone passionate about building healthier communities, inviting all to contribute to the mission.

For more information, visit the official project website.

JACARDI’s synergies with Action Grants: reducing the diabetes burden together

The four projects – DUSE, PIA, PREACT, PoDiaCar — and JACARDI are fundamentally anchored in the same mission: addressing the immense public health: the burden of Non-Communicable Diseases (NCDs), particularly Type 2 Diabetes (T2DM) and Cardiovascular Diseases (CVD). The shared approach of these actions universally champions prevention over treatment, implemented through strategies focused on early intervention, education, and sustained behavior change. 

A central demographic synergy is the heavy focus on empowering youth, with four projects targeting children, adolescents, and students in school and community settings to establish healthy habits early. This wide-reaching effort is facilitated by robust cross-national collaboration, involving large consortia to ensure methods are scalable and evidence-based across diverse regions. 

Furthermore, the projects demonstrate a strong commitment to addressing health inequalities by focusing interventions on vulnerable populations, including migrants and refugees. Synergistic actions involve JACARDI sharing its “4Cs” framework for integrating equity and diversity principles, providing a structured approach for the Action Grants to design inclusive interventions. 

Leveraging the advancements of technology, all initiatives integrate digital solutions  to modernize health management and engagement: DUSE uses a serious gaming app and empowers students to build their own health-tracking applications using the MIT App Inventor. PoDiaCar exhibits significant medical innovation by developing an Advanced Screening Tool and a Personalized Digital Twin to predict and simulate a child’s health pathway over time. Furthermore, PIA contributes digitally by developing a mobile application and remote monitoring tool for proactive health management. PREACT ensures real-world impact by finalizing and testing a comprehensive, evidence-based educational toolkit in community settings.

Implementation synergies are further supported by JACARDI sharing resources like the Ophelia methodology (Optimising Health Literacy and Access) to enhance Health Literacy tools within Action Grants like DUSE, PIA, and PREACT, ensuring educational content is accessible and culturally appropriate for targeted high-risk groups. This intensive cooperation across technical work packages, including collaborative development of standardized screening protocols (JACARDI Work Package on Screening, PIA, PREACT), ensures methodological consistency and enhances the scalability of effective prevention strategies across Member States.

Collectively, these projects contribute to a unified, technologically informed movement committed to cultivating healthier, more informed generations across Europe.

DUSE: Educating Youth for Lifelong Health and Diabetes Prevention

The DUSE (Counteracting diabetes using interdisciplinary educative programs) project addresses type 2 diabetes mellitus (T2DM), one of the most pressing public health challenges of our time. T2DM is classified as a lifestyle-related Non-Communicable Disease (NCD). It is often connected to modifiable risk factors, including obesity, physical inactivity, and unhealthy eating habits.

DUSE’s approach focuses strongly on prevention rather than cure. The core mission is to educate and empower children and adolescents to adopt and sustain healthy habits from an early age. This goal is achieved by promoting long-term well-being through regular physical activity and good nutrition.

DUSE launched in January 2024 and is scheduled to conclude in December 2026.

The consortium delivering the interventions includes partners from four participating countries: Italy, Greece, Romania, and Ukraine. The project is coordinated by Prof. Milena Raffi, Associate Professor in Human Physiology, University of Bologna.

The primary target audience consists of children and adolescents. During the first year of the project, the consortium successfully provided interventions to 463 kids across 10 schools. This work in Ukraine is particularly noted for giving children facing stress and uncertainty a sense of agency.

Prof. Milena Raffi, project coordinator, stated that DUSE is helping students build the curiosity, confidence, and skills required to take ownership of their well-being, demonstrating that prevention can be empowering and start early.

The project implements a truly interdisciplinary journey. Educational activities have included a variety of teaching methods:

• Nutritional and cuisine lessons;
• Interactive lectures;
• Physical activity training;
• Group works and physical activity days;
• Students have specifically delved into subjects like nutrition science, endocrinology, and physiology.

PhD student Michela Bridi shared that it was inspiring to witness the children’s enthusiasm when they learned how to read food labels or design meals that were balanced.

DUSE harnesses mobile technology and innovative tools to engage students:

• Students are engaged through a serious gaming app, which is a digital game designed to help them learn, train, or build healthy habits for real life.
• The project uses the MIT App Inventor platform.
• Students are encouraged to participate in app development labs and build their own health-tracking apps.
• These innovative tools foster both self-awareness and a mindset geared toward digital innovation and entrepreneurship.

In its first year, the project has  successfully engaged  463 children in 10 schools within the four partner countries.

Project leaders and participants have shared insights on DUSE’s impact:

• High school student Daniel reflected that designing an app about healthy habits helped him realize how much technology can assist people in living better, emphasizing that the process involved creating something meaningful for themselves and others.
• Oleksandr Fomichov noted that in Ukraine, DUSE provided children facing “enormous stress and uncertainty” with hope, knowledge, and a sense of agency. This engagement shows that empowerment and prevention can “thrive even in times of disruption”.

As the school year continues, follow-up evaluations will be conducted. These evaluations will measure how the students’ behaviors and attitudes have evolved, specifically utilizing questionnaires and the analysis of food diaries.

DUSE is defined as more than a project, it is a movement toward cultivating a healthier generation. Everyone is invited to follow the progress and remain engaged. By working together, the goal is to help the next generation gain control of their health through smart choices.

For more information, visit the DUSE website.

Career interventions for people with non‑communicable diseases

Scientific publications by JACARDI

In this post series we share the scientific publications directly linked to the JACARDI project. All publications featured in this series are authored or co-authored by JACARDI partners and reflect research and findings developed within the project framework.  

We aim to showcase how evidence supports our joint mission to tackle cardiovascular diseases and diabetes across Europe. 

Stay informed on how JACARDI turns evidence into action. 

Keywords Non-communicable diseases · Career intervention · Inclusion · Work ability · Chronic diseases

Authors: Martina Lanza, Alessia Marcassoli, Leonardi Matilde ,Guastafierro Erika, Ewelina Chawłowska, Agnieszka Lipiak, Maria Nowosadko, Barbara Gawłowska, Fornari Arianna

Abstract:

Aim Non-communicable diseases (NCDs) are medical conditions associated with long duration and slow progress. Many working-age persons with chronic conditions face job-related difficulties. The aim of this scoping review is to provide evidence about career interventions implemented in Europe for people with non-communicable diseases.
Subject and methods Studies were searched using PubMed and Scopus electronic databases and the selection process followed the Population Concept Context framework. The Mixed Methods Appraisal Tool was used to assess the quality of studies included. The search string was based on two main terms: “health condition” and “intervention in the labour setting”.
Studies conducted in European countries and published in English between 2020 and 2024 were included.
Results A total of 830 studies were screened and five were finally included. Quality assessment score ranged from 40 to 100%. Most of the studies describe interventions provided in clinical settings involving mainly healthcare professionals.
All included studies aimed to increase healthcare professionals’ knowledge on managing chronic diseases at work and/or to support patients’ return to work. However, no companies or employers were involved in the implementation strategies, highlighting an important gap in the application of interventions in a real-world context.
Conclusion The evidence on workplace interventions for workers with NCDs in Europe is very limited. Existing initiatives focus largely on healthcare-based approaches and professional training but without translation into real-world workplace contexts. Strengthening communication between healthcare systems, occupational health services, and business organizations is essential to develop and implement feasible interventions. As the number of working-age persons with non-communicable diseases is increasing and will probably increase in the future, supporting this group’s work ability constitutes an urgent public health challenge.

Source: https://link.springer.com/article/10.1007/s10389-025-02640-9

European countries unite in Madrid to tackle health inequalities at the General Assembly of JACARDI

From 14 to 16 October 2025, Madrid hosts the third General Assembly of the Joint Action on Cardiovascular Diseases and Diabetes (JACARDI), gathering more than 200 participants from 21 European countries

• Discussions centre on health, equity, gender disparities, monitoring systems, sustainability across all the “patient journey”, and the forthcoming EU Cardiovascular Health Plan.
• High-level institutional representatives, including the European Commission, the WHO Regional Office for Europe and health authorities from Spain, together with key experts and representatives from the scientific and civil society, deliver keynote speeches setting the stage for dialogue with the aim to strengthen collaboration to reduce the burden of non-communicable diseases across Europe

Madrid, Spain – Equity in health remains one of Europe’s most pressing challenges. Differences in access to care, diagnosis, and treatment continue to shape health outcomes across the region. Gender is emerging as a particularly critical dimension, as women in Europe face worse outcomes in cardiovascular disease, from higher mortality after heart attacks to longer delays in receiving treatment. Furthermore, data from the European Society of Cardiology (ESC Atlas of Cardiology) reveals that 40% of women in the EU die from cardiovascular disease.

This challenging reality is at the centre of discussions at the Third General Assembly of the Joint Action on Cardiovascular Diseases and Diabetes (JACARDI), taking place in Madrid from 14 to 16 October and hosted at the Spanish Ministry of Health and the Ilustre Colegio Oficial de Médicos de Madrid.

The Assembly brings together more than 200 representatives from 21 European countries, including the European Commission, the WHO Regional Office for Europe, scientific societies, and patient organisations. This year’s programme places gender and equity at the heart of the agenda, alongside sustainability, data monitoring, and the forthcoming EU Cardiovascular Health Plan.

With equal access to prevention and care at the forefront, participants reflect on the progress made during the first two years of JACARDI to highlight lessons learned and barriers tackled while improving care pathways in diverse settings across European health systems. 

“At the heart of JACARDI is the belief that health systems must serve everyone, fairly and equally. That’s why equity and diversity are not side topics in JACARDI, they are central to everything we do. This General Assembly in Madrid is an opportunity to show that together we can accelerate the shift towards a more equitable and healthier future”, adds Dr Benedetta Armocida, JACARDI’s Coordinator.

“Women are more likely to die from a heart attack and yet remain underrepresented in clinical trials, leaving critical knowledge gaps that perpetuate unequal care. Recognising gender differences in cardiovascular disease is not about division, it is about improving care to meet the unique needs of everyone”, says Dr Héctor Bueno, co-leader of JACARDI’s Work Package on data availability and quality and group leader of the Multidisciplinary Translational Cardiovascular Research at the Spanish National Centre for Cardiovascular Research (CNIC).

In the spotlight: The Cardiovascular Health Plan

The meeting takes place at a pivotal moment as the European Commission prepares the Cardiovascular Health Plan. By connecting JACARDI’s insights and pilot experiences to this political momentum, the Assembly intends to strengthen motivation, collaboration, and collective capacity to reduce the burden of non-communicable diseases across Europe. To this end, there is a dedicated roundtable during the event focusing on the EU Cardiovascular Health Plan, featuring representatives from DG SANTE (the European Commission’s Directorate-General for Health and Food Safety), the European Public Health Alliance (EPHA), and scientific societies such as the European Society of Cardiology, the European Heart Network, the European Diabetes Forum and the International Diabetes Federation. 

Contributions from WHO Regional Office for Europe and the JA PreventNCD initiative on monitoring systems and reducing health inequities are included on the agenda as well as pilot experiences from Portugal, Spain, Iceland, Romania, Belgium, Ireland, Italy and Poland, highlighting early results from JACARDI’s 143 pilot projects.

The agenda also explores sustainability and the translation of evidence into policy, ensuring that JACARDI’s pilot actions contribute to long-term change. On October 15 and 16, dedicated sessions explore specific focus areas, such as health literacy, integrated care pathways, data accessibility, and patient self-management. These workshops are designed to facilitate in-depth discussions and promote actionable insights to enhance health outcomes across Europe.

About JACARDI:

JACARDI, a Joint Action of the European Union, is a collaborative initiative aimed at addressing the rising prevalence of cardiovascular diseases and diabetes. Through coordinated efforts among European member states, the program focuses on evidence-based strategies and best practices to prevent and manage non-communicable diseases effectively. JACARDI is conducting 143 pilots to test evidence-based practices for preventing and managing cardiovascular disease and diabetes, with 81 partner institutions across 21 European countries.

Adopting tailored interprofessional protocols in general practice

Scientific publications by JACARDI  

In this post series we share the scientific publications directly linked to the JACARDI project. All publications featured in this series are authored or co-authored by JACARDI partners and reflect research and findings developed within the project framework.  

We aim to showcase how evidence supports our joint mission to tackle cardiovascular diseases and diabetes across Europe. 

Stay informed on how JACARDI turns evidence into action.

Authors: Laurent Desmet, Eva Goossens, Peter Van Bogaert and Katrien Danhieux

Abstract:

Background As the burden of non-communicable diseases continues to rise, general practices in primary care face increasing challenges in delivering high-quality care while managing workload constraints. Interprofessional care models, supported by practice-tailored protocols, offer a promising approach to optimizing task shifting and enhancing care coordination. However, the transition towards protocol-based interprofessional care remains complex and understudied.
Objective This study explores the experiences of general practices in developing and implementing practicetailored protocols to facilitate interprofessional care. Using the Consolidated Framework for Implementation Research (CFIR), we identify key barriers, facilitators and strategies that support this transition.
Method We conducted a qualitative study in Flanders, Belgium, using semi-structured interviews with 33 healthcare providers from 18 general practices. Participants represented various disciplines, including general practitioners, nurses, dietitians and reception staff. A hybrid qualitative analysis was applied, beginning with an inductive analysis based on Braun and Clarke’s thematic approach, followed by a deductive phase guided by the CFIR-framework.
Results The findings highlight several key factors influencing the development and implementation of practicetailored protocols in general practices. Participants emphasized that clear task allocation and communication structures within protocols improved care coordination. External factors, such as financial constraints and high workloads, posed challenges, whereas collaborations with external healthcare providers facilitated interprofessional teamwork. Internal practice dynamics, including a shared vision, mutual trust, and structured team meetings, were identified as crucial enablers. At the individual level, motivation to adopt protocols varies, with some physicians expressing reluctance due to concerns about shifting patient relationships and increasing complexity in their caseloads. The implementation process benefited from a stepwise approach guided by a team leader, clear goal
setting, continuous evaluation and peer learning.

Source: https://link.springer.com/article/10.1186/s12913-025-13424-y

Evaluating the effectiveness of lifestyle education for individuals at increased risk of type 2 diabetes and cardiovascular diseases(Halt2Diabetes)

Scientific publications by JACARDI

In this post series we share the scientific publications directly linked to the JACARDI project. All publications featured in this series are authored or co-authored by JACARDI partners and reflect research and findings developed within the project framework.  

We aim to showcase how evidence supports our joint mission to tackle cardiovascular diseases and diabetes across Europe. 

Stay informed on how JACARDI turns evidence into action. 

Authors: Jorik Vergauwen, Fanny Monnet, Josefien Van Olmen, Edwin Wouters, Katrien Danhieux, Laurent Desmet, Monika Martens, Ruth Verdegem, Justine Vanhaecke, Aurélie Lampaert, Sabine Verstraete, Inge Everaert and William Leysen

Abstract:

Background Halt2Diabetes is a prevention initiative in Flanders, Belgium, targeting the rising prevalence of type 2 diabetes (T2D) and cardiovascular diseases (CVDs). The program uses a two-step approach to identify high-risk individuals and guide them towards healthier lifestyles, reducing T2D and CVD risk factors. Building on evidence that lifestyle interventions can prevent both conditions by addressing modifiable risk factors, this research evaluates the effectiveness of Halt2Diabetes as a scalable real-world intervention and its potential as a blueprint for other contexts.
Methods The Halt2Diabetes program identifies high-risk individuals using the Finnish Diabetes Risk Score (FINDRISC) through an online risk assessment tool. Eligible participants, referred by general practitioners, participate in six groupbased lifestyle guidance sessions led by trained dietitians, focusing on healthy eating, physical activity, and behavior modification. This longitudinal study employs repeated measurements at five time points over 18 months. Primary outcomes include changes in body weight, waist circumference, and hemoglobin A1c (HbA1c) levels. Secondary outcomes encompass blood pressure, cholesterol levels, physical activity, and dietary habits. Data collection involves self-reported questionnaires, biochemical measures, and anthropometric assessments. Analysis will examine longitudinal changes in health and behavioral outcomes among participants.
Discussion This study will provide evidence for the real-world effectiveness of Halt2Diabetes in promoting sustained lifestyle changes and reducing T2D and CVD risk factors. Despite challenges including participation barriers and data integration needs, the program’s scalable, digitalized risk assessment model shows promise for broader application.

Source: https://link.springer.com/article/10.1186/s12889-025-24462-w

From evidence to impact: a united call for equity-driven and sustainable action on NCDs

• JACARDI, JA PreventNCD, WHO Europe, OECD and the European Commission’s DG SANTE have published a joint Comment in The Lancet Regional Health, based on the findings of the newly published report ‘Avoidable mortality, risk factors and policies for tackling NCDs: leveraging data for impact’, by WHO Europe.
• The Comment underscores the critical role of cross-national collaboration in translating WHO findings into actionable policies, with a focus on equity, data-driven solutions, and integrated care pathways.
• These organizations call for an accelerated, harmonised and equity-driven European agenda on non-communicable diseases.

Non-communicable diseases (NCDs) remain the leading cause of death and disability in Europe, and recent trends reveal both progress and setbacks. While tobacco use, hypertension prevalence, and alcohol consumption have declined since 2010, obesity and diabetes rates continue to rise alarmingly, and physical inactivity shows no signs of improvement. This mixed picture is compounded by a slowdown in the implementation of vital public health policies since the COVID-19 pandemic.

These findings are discussed in a Comment published in The Lancet Regional Health and developed through a collaborative effort bringing together JACARDI, JA PreventNCD, WHO Europe, OECD (Organisation for Economic Co-operation and Development), and the European Commission’s DG SANTE. The publication summarises the findings of the report Avoidable mortality, risk factors and policies for tackling noncommunicable diseases – leveraging data for impact: monitoring commitments in the WHO European Region ahead of the Fourth United Nations High-Level Meeting, by WHO Europe, reinforcing the urgency of renewed action. It emphasises the need for comprehensive solutions that prioritise strengthening health systems, accelerating the implementation of proven interventions, effective policies, and integrating equity-driven approaches.

The Comment presents key insights taken from the WHO Europe Report on the current state of NCD prevention and management in Europe. It highlights key challenges, such as the decline in the number of countries that have fully implemented NCD surveys, which fell from 28% in 2021 to 19% in 2023, and the reduction in the number of countries with operational multisectoral NCD strategies, which decreased from 60% to 55% during this period.

Despite these challenges, the authors note that 85% of European countries have adopted management guidelines for the four major NCDs: cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases; demonstrating significant foundational progress.

“These figures paint a complex picture. Despite decades of progress in reducing premature mortality from the four major NCDs prioritised by global agenda, currently the region is off track to meet its 2025 targets. Moreover, the rise in obesity and diabetes and the slowdown in policy implementation highlight the urgent need to reinvigorate our efforts”, comments first author Dr Benedetta Armocida, from the Department of Cardiovascular, Endocrine-metabolic Diseases and Aging at Istituto Superiore di Sanità-ISS, Rome (Italy) and Coordinator of JACARDI.

The Scientific Coordinator of JA PreventNCD, Prof Knut-Inge Klepp, concurs and is particularly concerned regarding the slowdown in the implementation of population level policy interventions:

“We know how critical such policies are if we are to succeed in having a significant and lasting impact across population groups in Europe. Inequalities in NCD-related health remain a key challenge across and within European countries”.

Driving change

The European Union’s flagship initiatives under the EU4Health Programme are pivotal in addressing these challenges. JACARDI and JA PreventNCD are at the forefront of strengthening cross-national collaboration and implementing integrated strategies for NCD prevention and management.

JA PreventNCD targets primary prevention by tackling root causes such as unhealthy diets, tobacco and alcohol use, and lack of physical activity. JACARDI, meanwhile, focuses on secondary and tertiary prevention, aiming to enhance outcomes for cardiovascular diseases and diabetes through evidence-based interventions and integrated care pathways. Together, these initiatives exemplify the EU’s commitment to tackling NCDs across the care continuum, supported by a combined budget of €160 million and participation from 27 European countries.

The WHO NCD Global Monitoring Framework, which includes nine global voluntary targets, notably the headline goal of a 25% reduction in premature mortality from NCDs by 2025, is about to expire. That is why the authors provide a clear roadmap for advancing the fight against NCDs, ensuring systematic policy implementation and strengthening data infrastructures to translate commitments into measurable health outcomes.

“There are no more excuses. We have the knowledge and the tools. What remains is the will to implement them swiftly and hold ourselves accountable for delivering real results. This is not just a matter of public health; this is a matter of justice, security, and competitiveness, and a shared future”, says Dr Hans Henri P. Kluge, World Health Organization Regional Director for Europe.

Armocida and Klepp underscore the power of collaboration in achieving meaningful change: “We truly believe this joint effort reflects the strength and unity across Europe, bringing together a diverse group of organisations, initiatives, and stakeholders committed to reducing the burden of NCDs. The collaborative authorship of this Comment itself serves as an example of the collective commitment and shared vision needed to address one of the region’s most pressing public health challenges.”

The Comment calls for an accelerated, harmonised, and equity-driven European agenda on NCDs, particularly in the lead-up to the 2025 UN High-Level Meeting on NCDs.

The JA PreventNCD and JACARDI Joint Actions encourage policymakers, researchers, and public health advocates to explore this vital publication and join in building a healthier, more equitable future for Europe.

JACARDI (Grant Agreement 101126953) and JA PreventNCD (Grant Agreement 101128023) projects have received funding from the EU4Health Programme 2021-2027.

Charles Agyemang: The challenge, especially with minority populations, is building trust

Some communities may seem hard to reach, but the real issue is that we don’t know how to connect with them, says Charles Agyemang, professor of Global Migration, Ethnicity and Health at the University of Amsterdam. As a member of JACARDI’s Scientific Advisory Board and an expert on ethnic inequalities in health and non-communicable diseases, he shares his experiences in working to connect with and empower minority communities. We also discussed the importance of addressing diversity in Europe and how JACARDI is leading the way.

What significance does JACARDI hold for you and your organisation in terms of its mission and values?

JACARDI is bringing a new dimension and aims to change the way things are done at the European level. The extensive network provides an excellent opportunity to interact with people, re-evaluate existing practices, and learn from other countries. It is quite exciting that JACARDI places inequalities at the center of its focus.

For me and my team, this is an opportunity to learn about what is happening across Europe and to contribute to ensuring that care and services related to cardiovascular disease are delivered equitably across Europe, taking into account people from diverse backgrounds such as migrant and ethnic minority groups.

How do you see JACARDI’s role in tackling the increasing prevalence of CVDs and diabetes in Europe?

Over the years, many countries have been working on cardiovascular diseases, but often in silos. When it comes to diversity and its various aspects, such as ethnicity and gender, many countries have been addressing these issues in their own ways and often with limited attention.

Now JACARDI provides an opportunity to raise awareness, share best practices among countries, and develop excellent ideas that can be implemented locally. It also allows countries to assess how far they have progressed, and engage with others in the process. More importantly, it ensures that countries are not working alone in silos. They have a network of people to rely on and seek input from when needed, fostering a collective responsibility to address this issue at the European level.

What is our role in promoting equity in healthcare?

Diversity cuts across the entire project, which is what makes it unique. In other words, regardless of what you are working on in your country, it is essential to apply a vested lens to it. I believe that adopting diversity as a horizontal approach should be the approach that is taken across the world. 

This is the flagship element of the project. Everyone involved is expected to take it seriously and actively work on it. Having a dedicated work package focused on this ensures a constant reminder and provides a source of support for those seeking help. Some countries are more advanced in addressing these themes, and this project creates an opportunity to support countries that are less developed in their approach to diversity.

One important issue is the sustainability of the project’s results. There should be a plan and funding to enable the implementation of the diversity lens across all of Europe and ensure equitable healthcare for everyone regardless of ethnic background, gender, sexual orientation and so forth after JACARDI.

How do you see the significance of considering cultural diversity in the development of treatment for diabetes and cardiovascular disease and what is the most critical aspect of this?

The fact of the matter is that Europe today is very diverse, especially in urban centers. This is a reality, and we must address it. Diversity plays a crucial role in cardiovascular diseases, and understanding it is key to addressing inequalities in health and healthcare.

It also makes economic sense to address these gaps. For example, if we know that a specific group is affected by hypertension and we ignore this, individuals may eventually end up in the hospital with strokes, and society will bear a heavy cost of treating and caring for stroke patients. We should focus on the individuals or groups most affected and implement effective interventions to support them in living healthier lives.

Many of these inequalities are tied to social determinants of health and access to resources. For example, not everyone has the privilege of living a healthy life because of financial constraints, which may prevent them from buying healthy food. No matter how much health information you provide to specific communities, it is not going to be effective if their social and economic circumstances are not right. There must be a plan backed by resources to simultaneously promote healthy life and improve social and economic circumstances among a culturally diverse population.

Do you have any tips or valuable experiences on how to implement research findings in healthcare to benefit both the system and the patients?

It is crucial to involve the communities that matter from the very beginning of the implementation process. Their voices, especially those that are often unheard, must be included. We need to empower these communities, ensuring they are not just recipients but co-creators of the initiatives. By working together with communities from the start, we can ensure that the program is meaningful and sustainable. 

Often, there is a tendency to go into communities and tell them what they should do. Instead, we should focus on ensuring that people are actively engaged in decisions, so that they take ownership of the program. When communities take ownership, they are more likely to ensure the program’s continued success after its initial implementation.

It’s crucial to recognize that long-term commitment is necessary for the success of a program. Governments must invest in supporting communities, especially those from lower economic groups and minorities, as it offers long-term benefits.

Do you have advice on how we can reach different communities?

People often say some communities are “hard to reach,” but the real issue is that we don’t know how to connect with or reach them. In fact, these communities are quite accessible if we approach them the right way and through proper channels.

The challenge, especially with minority populations, is building trust. To truly connect with people, we need to focus on establishing trust and building bridges. It’s about making people feel comfortable and valued. We need to invest time, establish relationships, and co-create with them.

Many times, researchers only engage when they need something, but we should connect even when we don’t need anything. By forming relationships and spending time with communities, it becomes easier to reach out when the need arises.

Charles Agyemang is a professor of Global Migration, Ethnicity and Health at Amsterdam University Medical Centres, University of Amsterdam. He is currently the Vice President of the EUPHA Migrant health section, Secretary of EUPHA’s Governing Board and Scientific Chair of the Global Society of Migration, Ethnicity, Race and Health. He is also a member of the prestigious US National Academy of Medicine and The European Academy. His work focuses on migration and health, particularly in relation to cardiovascular diseases. One of his most notable projects is the RODAM study, which investigates obesity and type 2 diabetes among African migrants.

Learn more about Charles Agyemang and his work here and connect on Linkedin here