Milka Sokolović: JACARDI is a beacon of proactive change in Europe’s healthcare landscape

Promoting healthy eating habits and regular physical activity can greatly reduce the risk of non-communicable diseases, but the responsibility cannot fall solely on individuals. This is the approach championed by Milka Sokolović, Director General of EPHA, the European Public Health Alliance, and a member of JACARDI’s Stakeholder Advisory Board. Strong public health policies are crucial in ensuring access to healthy food options and encouraging physical activity. JACARDI plays a key role in driving these efforts, fostering cross-sector collaboration and advocating for policies that empower individuals to make healthier choices. At the same time, we must harness the power of civil society and advocate for stricter regulations on industries that harm health, including the tobacco, alcohol, and ultra-processed food sectors.

What does JACARDI mean to you and your organization in terms of its mission and values?

For EPHA and myself, JACARDI is a crucial initiative in combating cardiovascular diseases, diabetes, and other non-communicable diseases in Europe. Its focus on prevention, disease management, and cross-sectoral collaboration aligns with EPHA’s values of health equity and evidence-based policy. JACARDI’s comprehensive approach addresses these conditions and considers the broader social and commercial determinants of health, enhancing our joint advocacy for sustainable public health policies in the EU.

Based on your experience in public health, what do you consider the main barriers to reducing the prevalence of cardiovascular disease (CVD) and diabetes in the EU, and how can these challenges be addressed?

Public health, particularly regarding non-communicable diseases like CVDs and diabetes, faces many challenges, including the influence of health-harming industries and varying public health policies across member states. To effectively counter these diseases we advocate for more stringent regulations on industries that negatively impact health, such as the tobacco, alcohol and ultra-processed food sectors. It is also vital to improve the coordination and integration of health policies across the EU for greater efficiency and uniformity.

Bridging the gap between political action and healthcare practice requires early stakeholder input in policy making. Leveraging the collective strength of civil society to advocate for these changes and prioritising public health in the political agenda is essential. JACARDI’s work addresses many of these critical areas.

In your experience, what are the most critical economic and political factors to consider when implementing health initiatives across different global settings?

Effectively addressing cardiovascular disease and diabetes requires understanding both economic and political contexts. Economically, resource availability and stable health financing are crucial for sustaining initiatives. Politically, long-term commitment from governments and stakeholders is necessary to implement robust health policies. Early engagement with policymakers ensures health initiatives align with regional and national priorities, improving their effectiveness.

The JACARDI model, emphasising cross-country and sector cooperation, including other joint actions like the JA PreventNCD, offers a blueprint for addressing these challenges. Through collaboration, JACARDI enhances the implementation of adaptable and resilient health strategies, serving as a framework for other global health initiatives.

What role do lifestyle changes, such as diet and physical activity, play in the prevention and management of CVD and diabetes, and how can public health policies better support these changes?

Lifestyle changes are fundamental in the prevention and management of cardiovascular diseases (CVD) and diabetes. Encouraging healthy eating habits and regular physical activity can significantly reduce the incidence of these conditions, but it cannot rely solely on the individual. Public health policies play a key role by facilitating access to healthy food options and promoting physical activity through the creation of safe and accessible public spaces.

Integrating lifestyle interventions into national health policies can have a positive impact on public health. From JACARDI’s perspective, this is being addressed through initiatives that improve health literacy and encourage active participation from diverse populations. Furthermore, educational campaigns and programmes in schools and workplaces can motivate behavioural changes.

Finally, comprehensive policy approaches are crucial and it is essential that public policies tackle health misinformation and provide citizens with the necessary tools to assess the information that they are exposed to.

How do you see JACARDI’s role in addressing the growing prevalence of cardiovascular disease and diabetes in Europe?

JACARDI is a beacon of proactive change in Europe’s healthcare landscape. Its comprehensive approach to disease management and prevention addresses the rising prevalence of CVD and diabetes, focusing on prevention, early diagnosis, and effective management.

Beyond immediate health interventions, JACARDI integrates diverse healthcare approaches, ensuring inclusivity and adaptability for both urban and underserved populations. This ensures no one is left behind. Through these efforts, JACARDI strengthens European health systems’ ability to manage and prevent these diseases, promoting a healthier and more equitable future for all European citizens.

In a career that spans a quarter of a century and three countries, it was her unceasing quest for more impact and purpose in her work that brought Milka Sokolović to EPHA. As Director General, she instigates alliances and forges partnerships, while advocating for equitable solutions to European public health challenges, insisting on the vital role of civil society in reaching those solutions.

Milka Sokolović holds a degree in Biology from the University of Belgrade, and a PhD in Medicine from the University of Amsterdam. Through her research and academic roles at the Universities of Belgrade and Amsterdam, and her leadership roles at the European Food Information Council (EUFIC) and the European Nutrition Leadership Platform (ENLP), she has developed a remarkable expertise in scientific research, communication, and strategic partnerships.

Milka is skilled at developing and implementing organisational strategies, equipped with robust leadership competencies, and armed with ample enthusiasm, driven by Goethe’s “Knowing is not enough, we must apply. Willing is not enough, we must do.”

Learn more about EPHA here and connect with Milka Sokolović here.

Francesco Cosentino: Policy change can only happen when it is driven both at EU and national level

As the European Commission prepares to launch the European Cardiovascular Health Plan, recognizing the strong link between cardiovascular disease and diabetes is more important than ever. However, for real impact, the plan must provide funding that reflects the scale of the CVD burden, says Francesco Cosentino, Vice-President of the European Society of Cardiology (ESC) from 2020 to 2022, and a member of JACARDI’s Stakeholder Advisory Board. JACARDI’s work in optimizing the availability of health data can play a vital role in shaping future policies and ensuring data availability will also be key to improving adherence to guidelines.

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

The mission of the European Society of Cardiology (ESC) is to reduce the burden of cardiovascular disease (CVD). Our society is very supportive of the great work being undertaken through JACARDI, which aims to support European countries in reducing the burden of CVD and diabetes and improve quality of care for the individuals affected.

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

I believe that JACARDI, through its numerous science-based pilot projects in 18 EU countries and with its network of 76 partners, has great potential to foster community spirit, knowledge sharing and to create value for tackling the increasing prevalence of CVD and diabetes across Europe. I think that JACARDI’s main strength is the integrated approach addressing both diseases simultaneously with a focus on the entire patient journey.

How do you think JACARDI will influence future collaboration on cardiovascular disease and diabetes prevention in Europe?

JACARDI specifically reflects the realities of patients who live with two comorbidities. We know CVD remains the predominant cause of death and disability in Europe. In the European Union, 62 million people live with CVD and close to 30 million new cases are diagnosed every year. In addition, 1 in 10 adults live with diabetes. What we also know is that people with diabetes have a two to three times higher cardiovascular risk than people without diabetes. They also see their life expectancy reduced by 10-14 years.

It is important to diagnose CVD and diabetes as early as possible to prevent complications and reduce healthcare costs. Recognizing these interlinkages between these two comorbidities is also crucial in the context of the incoming European Cardiovascular Health Plan from the European Commission. I believe that diabetes will be included within this plan.

So, joint health checks based on common risk factors for both diseases, such as high body mass index (BMI), high blood pressure, tobacco and alcohol consumption, high blood glucose and high LDL cholesterol are sensible and cost-effective options for the identification of high cardiovascular risk in individuals.

Based on your experience chairing the ESC Guidelines on Diabetes and Cardiovascular Disease, how can JACARDI’s research contribute to shaping future clinical guidelines in Europe?

Our ESC Guidelines on Diabetes and Cardiovascular Disease are an excellent tool to implement evidence-based, person-centered treatment strategies. This is what we call personalized medicine, which we know is effective in reducing cardiovascular risk in patients with diabetes. I believe that findings from JACARDI may potentially help the implementation of our guidelines in the daily clinical practice.

A critical step is ensuring that the clear target outlined in the ESC guidelines, to achieve better outcomes for people living with diabetes and CVD, is met for all patients. However, we are not there yet.

In this regard, data availability, data sharing and utilization are really crucial to improve patients’ and healthcare professionals’ adherence to the guidelines. One of the Work Packages of JACARDI aims to optimize the way individuals, communities, and organizations access, understand and use health information. These can be very helpful in shaping future guidelines.

With your background in cardiovascular pharmacology, what role do you think pharmacological innovations will play in complementing JACARDI’s efforts to reduce the burden of cardiovascular disease and diabetes?

I believe that a wide range of stakeholders have an important part to play in improving cardiovascular health in our population. This also includes the innovations coming from pharma and device companies. We hope that the innovation pipeline will continue to improve in the coming years as many clinical needs remain unmet.

Collaboration is definitely key and this is why the ESC is also a proud partner of the European Alliance for Cardiovascular Health (EACH), which comprises 21 leading organizations, including medical societies, industries and patients organizations.

Given your leadership experience in the European Society of Cardiology, how can JACARDI help drive policy changes at the European level to improve cardiovascular and diabetes care across diverse healthcare systems?

The ESC together with the European Alliance for Cardiovascular Health, has been advocating for a European Cardiovascular Health Plan for many years. Now finally, the policy context is extremely positive. The President of the EU Commission put CVD on the agenda and the Commissioner for Health has committed to developing a European Cardiovascular Health Plan, similar in ambition to Europe’s Beating Cancer Plan.

This was announced on the 3rd of December 2024, on the same day the Ministers of Health from the 27 Member States of the European Union approved the Council Conclusions on the Improvement of Cardiovascular Health in the EU.

It is clear that the plan is coming. What we need to ensure is that there is significant funding attached to the plan, proportionate to the burden of CVD. I believe the magnitude of work and effort from JACARDI also shows the interest at Member State level of this being a priority topic.

Policy change can only happen when it is driven at both the EU and national levels. And JACARDI showcases this important complementary nature with 80% of the close to €60 million in funding coming from the EU and the remaining 20% from the 21 participating European countries. I think collaboration is key and the driving force behind making real progress.

Prof. Francesco Cosentino is a Professor of Cardiology at the Karolinska Institute and University Hospital in Stockholm, Vice-President of the European Society of Cardiology (ESC) from 2020 to 2022 and co-Chair of the ESC Advocacy Committee from 2022 to 2024. He chaired the 2019 ESC Guidelines on Diabetes and Cardiovascular Disease and serves as Deputy Editor of the European Heart Journal and Consulting Editor of Cardiovascular Research Journal.

As a leading researcher, he has received grants and awards from national and international research councils and private foundations and has authored over 200 original articles in top-ranking, peer-reviewed journals. As a member of JACARDI’s Stakeholder Advisory Board, he contributes to work packages focused on data insights (WP7), screening (WP8), patient pathways (WP9), and patient self-management (WP10).

Learn more about Francesco Cosentino and his work here, and about ESC here.

Bart Torbeyns: JACARDI’s unified strategy makes perfect sense

Meet Bart Torbeyns, the Executive Director of the European Diabetes Forum (EUDF) and a pivotal voice in the fight against diabetes and cardiovascular disease. As a member of JACARDI’s Stakeholder Advisory Board, Bart commends JACARDI’s integrated approach to addressing both diseases simultaneously. “For primary care physicians and patients managing multiple chronic conditions, JACARDI’s unified strategy makes perfect sense,” he observes. Bart passionately advocates for the elimination of discrimination against individuals living with diabetes and establishes that the critical step for lowering its burden is establishing clear targets through better data.

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

At its core, JACARDI is about improving outcomes for people living with diabetes and cardiovascular disease. While I work for the united diabetes community, we’re acutely aware that many of the people living with diabetes also face cardiovascular risks and, in some cases, complications. What makes JACARDI so valuable is its focus on the entire patient journey, starting with health literacy, labor participation, patient pathways, screening, and better management. These areas are still critically needed across many European countries.

For example, in the area of screening, we know that up to one in three people with diabetes are unaware they have the disease, reaching one in two in certain countries. These individuals, by definition, are not receiving education or proper treatment, leading to severe complications. Addressing these gaps is fundamental to the work we do.

How do you think JACARDI’s work aligns with promoting the overall well-being of patients?

The well-being of people with diabetes is crucial, and JACARDI’s work aligns perfectly with this focus. Health literacy and labor participation are especially vital in this context. Self-management is another key element. When people are well-treated, well-managed, and educated about their condition, they gain confidence in how to handle it, which provides peace of mind.

This is particularly important for families, parents, and teachers who support younger individuals with type 1 or type 2 diabetes. The better they understand the disease, the better the overall well-being of those involved.

Labor participation is another critical area. Unfortunately, discrimination against people with NCDs, including diabetes, still exists. Many individuals hesitate to reveal their condition, for instance, I know people who would never inject insulin publicly and instead hide to do it. It’s crucial to combat this stigma. People with diabetes can make valuable contributions to the economy and society. I’ve encountered many brilliant individuals with diabetes, and ensuring they have opportunities to participate fully is essential for their well-being but also for our economy and society. The work JACARDI is doing on labor participation is a prime example of addressing these challenges.

What are the most critical next steps for Europe in addressing the dual burden of cardiovascular disease and diabetes?

A critical step is establishing clear targets to achieve better outcomes for people living with diabetes and cardiovascular disease. This process begins with better data, improving its availability, sharing, and utilization. For instance, many European countries don’t even know how many people in their population have diabetes. Without this basic information, it’s difficult to make progress.

Once we have reliable data, the next step is setting targets to improve results and prevent complications. What I particularly appreciate about JACARDI is its collaborative approach, bringing together the cardiovascular and diabetes communities. There’s so much we can learn and share from each other.

By adopting a patient-centric perspective, it’s clear that many people with diabetes are at high risk of developing cardiovascular disease, and the reverse is also true. Often, we think in silos, creating separate plans for diabetes, obesity, or cardiovascular disease, but for primary care physicians and patients managing multiple chronic conditions, JACARDI’s unified strategy makes perfect sense, and that’s an approach I fully support.

Recently the new Commissioner for Health and Animal Welfare, Mr. Várhelyi, announced he will propose a comprehensive cardiovascular health plan that will also address diabetes and obesity. We very much welcome such a comprehensive approach and we are confident that JACARDI’s deliverables will be consolidated in this new plan.

Bart Torbeyns is a dedicated leader in public health policy and advocacy, with a focus on improving healthcare systems and addressing chronic diseases. With master’s degrees in Pharmacy and Business Economics from the University of Louvain, he has contributed to initiatives like the SUGAR and the DYSIS studies, generating vital local data for diabetes and atherosclerosis care in Belgium. He has worked as Head of Public Affairs in Belgium and Europe at MSD and Sanofi, and analyzed healthcare systems and developed strategies to promote equitable access to care. Now serving since 2020 as the Executive Director of the European Diabetes Forum (EUDF), he works to advance collaborative, patient-centered policies addressing diabetes and cardiovascular health across Europe.

Learn more about the European Diabetes Forum (EUDF) here and connect with Bart Torbeyns on LinkedIn here.

Janne Sørensen: Being aware of one’s own biases is part of a patient-centered approach

The diversity of JACARDI’s experts is a tremendous asset to the project, as it brings many different perspectives to the table, according to Janne Sørensen, diversity expert at the University of Copenhagen in the Department of Public Health. As a member of JACARDI’s Scientific Advisory Board, she shines a light on how vulnerable groups are impacted by diabetes and cardiovascular disease, and how healthcare professionals can better answer their needs. Her message to people working in healthcare is to see the whole person in front of them and to consider implementing equity as a lifelong learning process.

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

As a public health expert, one of the core elements of my work is addressing health inequalities and striving for greater health equity for all. JACARDI’s focus on combating these inequalities, particularly in the context of cardiovascular diseases and diabetes, resonates deeply with both my personal mission and the goals of my organization.

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

Well, this is a big question and a significant challenge, as diabetes is on the rise. We need to stop its progression and bring the situation under control. JACARDI is a large initiative and, I believe, a serious attempt to address this challenge. You are confronting the problem head-on with innovative approaches. JACARDI positions itself at the heart of the EU’s efforts to tackle this issue. It is an impressive project, and I am very happy to be part of it.

How do you see our role in promoting equity in healthcare?

JACARDI plays a significant role here because it aims to address inequalities. In other words, we see disparities affecting many vulnerable groups who are significantly impacted by these health issues. For example, people with lower socio-economic status, migrants, ethnic minorities, and LGBT groups all have a higher prevalence of diabetes and cardiovascular diseases.

I must say this is an ambitious objective for such a large project, and it might be quite challenging to mainstream diversity, reach everyone, and ensure that everyone adopts principles of equity and diversity.

How do you see the significance of cultural diversity in the development of diabetes and CVD treatment? And what is the most important or critical aspect of this?

This is significant because you are addressing these particularly vulnerable groups. It is therefore crucial to ensure that you consider meeting people with their diverse identities, vulnerabilities, and characteristics in order to effectively tackle the issues of diabetes and cardiovascular disease.

Implementing diversity can be challenging, but you’ve brought it to the forefront. Ideally, the insights gained from this project will inspire experts to incorporate them into their own work and organizations long after it concludes. JACARDI brings together a diverse group of experts, representing a wide range of educational backgrounds, nationalities, ethnicities, and experiences. This diversity is a tremendous asset to the project, as it brings many different perspectives to the table.

You are providing training for healthcare professionals on cultural diversity. Are there questions that professionals often ask?

Some people ask why it is necessary to discuss diversity, especially if they are already working with a patient-centered approach. My answer is always that while you might have a patient-centered approach, it doesn’t necessarily require that you, as a health professional, reflect on your own background, biases, and stereotypes. Understanding these is crucial when interacting with patients.

Additionally, we discuss health inequalities: that many people are worse off in terms of health because they have fewer opportunities from the beginning of their lives, simply because they belong to specific groups and face discrimination within the healthcare system. These differences also exist among various groups, such as people with disabilities or those from the LGBT community, and so on.

What is your message to healthcare professionals then?

My message is that you need to see the whole person in front of you, in addition to knowing the prevalence of diseases and risk factors and being able to diagnose. This is not easy, because as a healthcare professional, you have to consider many things during a short appointment.

I believe we are trying to improve communication and interaction between healthcare professionals and patients by raising awareness of the disadvantages the patient may face, as well as the risk factors. At the same time, it’s important to recognize what professionals bring into the meetings.

This is a lifelong learning process, not something that can be mastered through a short course. Applying these lessons in practice after completing a course is an entirely different challenge.

Janne Sørensen is a specialist in diversity and diversity competence, based at the Department of Public Health at the University of Copenhagen. Her work focuses on integrating diversity competence into medical education through training programs for students and healthcare professionals. Alongside her teaching, Janne conducts research on various aspects of diversity and addresses issues of discrimination within medical student communities.

Learn more about Janne Sørensen and her work and connect on LinkedIn.

Birgit Beger: An EU Cardiovascular Health Plan is the best way forward

Birgit Beger, CEO of the European Heart Network (EHN) and member of JACARDI’s Stakeholder Advisory Board, strongly believes that investment in health is a win-win for society overall. With the EU stepping up with the European Commission’s recent announcement of an EU Cardiovascular Health Plan, Birgit Beger shares her hope for an ambitious proposal by the European Commission in line with the work undertaken for the European Beating Cancer Plan. She sees JACARDI’s importance in leveraging knowledge and best practices across Europe and underscores the need to involve stakeholders early on, because they can help bridge the gap between policy and practice.

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

In line with EHN Strategy, JACARDI, with its joint action of European pilot projects to reduce the burden of cardiovascular diseases and diabetes, mirrors one of EHN’s core pillars: prevention. Furthermore, EHN supports JACARDI’s overarching goal of improving CVDs and diabetes in terms of disease management.

In your experience, what are the most pressing challenges in implementing effective healthcare policy at both the EU and national levels in the area of cardiovascular disease prevention?

There is a disconnect between the political and healthcare practice levels. For example, the pressing societal burden of cardiovascular diseases has only recently come to the attention of policy makers at national and European levels. The recognition of the urgency for action is growing and yet, given that we are speaking these days about a permacrisis, many politicians are dealing with a myriad of urgent priorities simultaneously. However, as has always been argued, investment in health is a win-win for society overall, financially, for social inclusion and cohesion. This is particularly relevant for cardiovascular disease (CVD), which is the number one cause of mortality and morbidity in Europe and globally.

EHN’s vision is that “every person in Europe should grow up and live in a sustainable environment which promotes cardiovascular health. Premature and preventable deaths due to cardiovascular diseases should be reduced by 30% in 2030. State of the art, personalised care and quality of life should be accessible and attainable for those born or living with CVD”. In this context, taking legislative action to reduce the impact of major risk factors for CVD (unhealthy nutrition, smoking, physical inactivity, air pollution and climate change, but also hypertension, obesity and high cholesterol levels) are of the utmost importance in reducing the burden of CVD.

This being said, not all CVDs are preventable. Therefore, it is equally important to invest in early detection and management of cardiovascular diseases, thereby enabling people who are at high risk of developing CVD, or who have already contracted a CVD, to actively manage their condition, so that they can live to a mature age, with a good quality of life.

What do you see as the key success factors for achieving long-term impact in reducing the prevalence and burden of CVD? How is the EU CVH plan coming along?

Indeed, EHN believes that an EU Cardiovascular Health Plan is the best way forward since it represents a structured and financed approach to combat the cardiovascular burden on society and the increasing CVD numbers, which are already emerging for 2023 and 2024 following the Covid-19 pandemic. We see that many Member States are taking action for national CVH plans, that the European Parliament is supporting a European CVH plan and we are pleased to hear that the European Commission President Ursula von der Leyen identified CVD as a new health priority for her renewed mandate. It is important that the European Commission comes forward with an ambitious proposal in line with the work undertaken for the European Beating Cancer Plan.

Therefore, we applaud wholeheartedly the recent adoption of Council Conclusions on the Improvement of Cardiovascular Health in the EU on 3 December 2024, as well as the commitment from the new Health Commissioner, Olivér Várhelyi, to develop a European Cardiovascular Health Plan. EHN particularly welcomes references made to prevention, women’s health and research. A strong focus on the patients’ voice will be a decisive quality element of such a future European plan. It will hopefully trigger efforts at national level to improve or develop national cardiovascular health plans.

How important are EU-funded projects like JACARDI in addressing NCDs, and what role do they play in complementing the work of other organizations like EHN?

JACARDI has a real potential to implement policy at national level and to make tangible inroads at the European level. It is very promising that so many health institutions are involved in leveraging knowledge and best practices across Europe. EHN is there to support and advise on the work, but also help to disseminate results across its membership.

As CEO of the European Heart Network, you have a unique perspective on the dynamics of cardiovascular health advocacy across Europe. What lessons from your experience there could be applied to projects like JACARDI to maximize their effectiveness?

It is most important to involve stakeholders early on because they can help bridge the gap between policy and practice. As EHN, we can bring expertise to the table from our members at national level, namely, the patient experience, but we also speak to national and European policy makers. In this way, projects such as JACARDI can be fast-tracked further to develop results, through our consolidated support, which will work in practice through the informed connections these layers will bring.

About Birgit Beger

With 22 years of EU public policy experience focusing on leading European Associations like Medical Doctors, Lawyers, Health NGOs, Birgit Beger is a well-respected senior executive. Birgit is a qualified lawyer and skilled communicator with senior management experience and diplomatic outreach to all political levels, both at the national and European level. She has brought considerable added value to the leadership roles she has held during her tenures as CEO of the European Cancer Organisation (ECCO), and as Secretary General of the Standing Committee of European Doctors (CPME). She is a member of WHO-Europe Regional Director’s Advisory Council on Innovation for Noncommunicable Diseases (the NCD Advisory Council) and is the CEO of the European Heart Network, a leading advocate and key partner in shaping and advancing the European Cardiovascular Health Plan.

Learn more about the European Heart Network here & connect on LinkedIn here.