Don't forget to wash your hands!

Abstract

tality. 2 This suggests that measures of abdominal adiposity, rather than BMI (which is confounded by effects of smoking and subject to reverse causality), should be used in assessing future burdens of cardiovascular disease associated with the obesity epidemic. Making comparisons between populations also helps us understand the environmental and social causes of cardiovascular disease risk. In this issue, we publish a review of the factors explaining the large variation in cardiovascular occurrence between countries. 3 The authors consider three ‘‘environmental influences’’ relevant to cardiovascular disease: tobacco; the obesogenic milleu; and air pollution. They state that the ‘general acceptance that population level influences are the most likely explanations of differences in CVD rates ... is largely a diagnosis of exclusion’. This perverse view is reflected in their conclusions of ‘more research needed’ and an emphasis on reducing CVD risk through ‘individually targeted interventions’ (otherwise known as polypharmacy—no conflict of interest here). It would be unfortunate if such views resulted in a slowing of public health action, particularly in developing countries. Implementation of World Health Organisation’s tobacco control framework 4 and its work on diet and activity 5 are vital if projected CVD epidemics are to be mitigated. Our commentators take a more positive stance, highlighting what can and should be done. 6