Ischemic Heart Disease Has Become a Global Failure of Public Health Justice -By Fransiscus Nanga Roka

Ischemic Heart Disease is more of a medical disease that occurs through the blockage in arteries, accumulation of cholesterol in blood vessels, hypertension, smoking or because of other unhealthy lifestyles. That explanation might be scientifically accurate if not politically complete.

Ischemic heart disease is no longer terminally a clinical entity in the modern epidemic. This is a global public health justice failure.

Millions of deaths each yeare are caused by mostly preventable cardiovascular diseases that can be avoided with early intervention, fair access to healthcare systems, healthy food systems and environment regulation at municipal levels and better public policy. But despite the great medical advances of recent decades, ischemic heart disease to this day is one of the most frequent causes of death all over the world. This paradox reveals a harrowing fact: while mankind has built an extraordinary ability to intervene on heart disease, there are no systems adapted for solidarity prevention.

That failure is not accidental. It is structural.

With disturbing precision, the global burden of ischemic heart disease tracks patterns of inequality. The greater risks are climbing among the populations exposed to chronic economic pressure, polluted environments or working in precarious conditions with limited access to quality healthcare and an urban infrastructure that favors sedentary lifestyles and excessive marketing of ultra-processed food products and tobacco. The risk of cardiovascular disease has its roots in many social factors long before anybody winds up in a hospital.

Poverty, in fact, has emerged as a cardiovascular risk factor.

It is for this reason that framing ischemic heart disease simply as a problem of “individual lifestyle choice” is so deeply misguided. You are a worker in overly laborious conditions trapped cycling the cheap, processed food flowing from faraway continents because healthier alternatives are out of economic reach; living in urban contexts vibrating with pollution, and cobbling medicines on pocket money when assiduously avoiding preventive care examination that might shed light on avoidable morbidity. This approach does not function within truly free health choices

Which gives those people whose existence is already lived in structural constraint against them.

The modern global economy creates conditions that increase cardiovascular risk, and contains an ideological logic of individualization. Governments promote stress, overwork, environmental destruction and unhealthy consumption driven economies, and then blame personal responsibility when citizens get ill with cardiac disease.

This is not health policy.

That is organized neglect masquerading as personal responsibility.

Some of the greatest whopper’s to this is exampled in fact by the pharmaceutical and healthcare industries. Billion dollar revenues are earned around the world in advanced cardiac interventions, surgical technologies and expensive medications. On the other hand, preventive healthcare, nutritional policy, exercise infrastructure, public screening programs (eg, for cervical or diabetes), anti smoking legislation and enforcement to reduce exposure to tobacco smoke and environmental health protections such as water purification has often been dangerously underfunded, relegated politically to the margins or opposed commercially.

It creates perverse incentives: A system that profits more from treatment than prevention.

The outcome is almost preordained: societies evolve to be exquisitely adept at dealing with heart attacks, while remaining politically disinclined to prevent the social conditions causing them.

Such dynamics appear especially prominent in low- and middle-income countries experiencing the double burden of escalating cardiovascular disease amid rapid urbanization, dietary transition, air pollution and inequitable healthcare globalization. This leaves millions in a cruel double bind – exposure to modern cardiovascular risk but lack of access to modern protection.

So in the context ischemic heart disease is no longer a medical condition. It is a map of inequity.

The international heart failure crisis also exposes the limitations of global health governance itself. International bodies frequently recommend interventions to improve nutrition, reduce smoking, control pollution and prevent non-communicable disease. But the enforcement mechanisms are still weak and multinational industries continue to market products closely associated with cardiovascular damage.

Ultra processed foods dominate markets. Tobacco industries adapt and survive.

Urban environments discourage physical activity. Air pollution remains politically tolerated.

And access to healthcare is still a matter of monetary privilege rather than basic human right.

Under these same conditions, public health rhetoric is at increasing risk of functioning as mere symbolic language devoid of substantial structural change.

Mortality is just the tip of the iceberg in case of ischemic heart disease. It normalizes homeopathic suffering in the planet. Cardiac death is now so core to the essence and being of our societies that it is as if we have come to regard it as a biologically determined process rather than something socially heightened.

What is quite different, nothing I would call inevitable is millions dying too young in as well with prevention, simply because it was too expensive.

This crisis calls for a paradigm shift in the understanding of cardiovascular disease. Ischemic heart disease can no longer be regarded simply as a biomedical problem. Also, it has to be framed as an issue of labor justice, environmental justice, food justice, economic justice and health care justice.

Arteries, after all, do not collapse in political solitude.

They buckle within systems defined by inequality, policy failure and commercial might.

A world that knows how to prevent cardiovascular disease but refuses to create equitable pathways for prevention is not facing a medical failure, it is revealing a moral one.

But a global health regime that normalizes preventable cardiac death while prioritizing the industries and policies that are driving it does not only fall short on public health, it legitimizes injustice in the language of care.

Fransiscus Nanga Roka

Faculty of Law University 17 August 1945 Surabaya Indonesia