Cardiovascular disease prevention policy in the four nations of the United Kingdom: a policy document analysis from 2000-2025
I Lyell, E Adrion, M Ramasawmy, A Banerjee, A Anand, N L MillsAbstract
Background
The prevention of cardiovascular disease in an equitable way is a public health priority across the four nations of the United Kingdom (UK). However, since the devolution of health policy, variation between UK nations has not been systematically explored. Understanding historical prevention policy context is critical to elucidate changes over time in policy priorities, differences between countries and signal future policy directions.
Purpose
The aim of this analysis was to systematically record and compare content and timelines of cardiovascular disease prevention policy in the four nations of the UK.
Methods
National policy documents referencing cardiovascular disease prevention published between January 2000 - July 2025 were included. Documents were identified through systematic site-specific (e.g. gov.uk) internet searches. Thematic analysis was used to code information related to the Walt and Gilson policy triangle framework (context, process, content and actors) and extract key document information to create a narrative policy timeline.
Results
From 179 screened documents, 84 were included with the majority (51) pertaining to England. Policy context emphasised the burden of cardiovascular disease on health and health inequalities and the opportunity for prevention with minimal explanation of policy formulation. The policy content focussed on the control of risk factors for cardiovascular disease, primarily taking a medical approach to case finding and management in primary care settings. 22 documents included behaviour change interventions whilst others simply referenced existing strategies (e.g. for diet and healthy weight). Educational approaches were included in 33 documents with four national awareness raising campaigns launched. Interventions taking a community empowerment or asset-based approach were less frequently described (12 documents). Social change approaches included food and drink reformulation and smokefree legislation, with some examples relying on voluntary pledges from industry. More recently published documents emphasised the opportunity for technology to improve prevention. Notable variation between countries included use of pay for performance schemes and variable introduction of “health check” programmes with England planning to expand the current programme and Scotland discontinuing its programme after an unfavourable evaluation.
Conclusions
There was a notable imbalance in the number of documents published between UK nations and variation in policy content. The medical model to address risk factors in the population was the dominant approach to cardiovascular disease prevention. The final publication of this analysis will include a web based interactive timeline of policies from the four nations so researchers and policy makers can situate their work within the historical policy context, and themselves easily interrogate policy differences between countries and over time.