Although Covid is the most visible pandemic of our lifetime, it is neither the deadliest nor the most preventable. That distinction goes to cardiovascular disease, a pandemic so common it is invisible, so routinely lethal it seems normal, and so ingrained in the fabric of modern society it seems natural. Every year, cardiovascular disease kills twice as many people, at a younger average age, as Covid has at its worst, and since 2020, there’s been a surge in fatalities from heart disease and stroke in the U.S.
Fortunately, we don’t need heroic medical innovation to turn back this pandemic. We already have the public health tools needed to prevent most early cardiovascular deaths. The question is whether we can muster the social and political will to use them.
First, some basics. In the first two years of the pandemic, Covid killed nearly 900,000 people in the U.S. In those same years, heart attacks and strokes killed more than 1.6 million. Globally, Covid killed more than 10 million people in the first two years of the pandemic; in the same two years, cardiovascular disease killed more than 35 million. The three leading drivers of heart attacks and strokes—accounting for around two-thirds of the global total—are tobacco use, hypertension and air pollution, and all three are preventable.
“Public health is about making collective decisions as a society that allow most people to make healthy choices by default.”
During the Covid pandemic, culture wars over masks, vaccines and closures have revolved around forcing people to do something or refrain from doing something. With cardiovascular disease, it simply wouldn’t work to try to force people to stop smoking, eat healthy food and wear protective masks all the time. In the U.S., we too often think of health as strictly the result of individual choices and of public health officials as grim taskmasters hectoring everyone to sit up straight, eat their vegetables and do calisthenics.
But that is not the way public health should work. When public health officials find themselves having to tell people what to do, it usually means that society has failed to make the collective decisions needed to ensure that healthy choices are the default option for most people. Individuals can do a lot to stay healthy, of course, through a range of personal decisions. The larger issue is what we do, as a society, to make it easier for people to make healthy choices.
Tackling these three killers—tobacco use, hypertension and air pollution—doesn’t require making radical changes in society. Americans still very much lived in the same country after we reduced the number of fatal car crashes by outlawing drunken driving, promoted child development by eliminating lead in paint and gasoline, and prevented food poisoning through regulations making food safer. But it does mean regulating companies that sell tobacco and unhealthy foods and cause air pollution so that they are forced to share some of the costs of the enormous harms they cause.
The first priority is to end the epidemic of tobacco use. Yes, parents can urge their children not to smoke, and individuals can…
Read More: Stopping a Pandemic Deadlier Than Covid