Cardiovascular disease remains Europe’s biggest killer. That is not new. What is harder to ignore is how unevenly the burden is shared, and how poorly that inequality is captured by a public debate that too often narrows heart health down to a list of foods people should avoid.
The latest European Society of Cardiology Atlas report offers a sobering picture. Across more than 50 countries, cardiovascular disease is responsible for more than 3 million deaths and 68 million healthy life-years lost each year. Middle-income countries continue to experience roughly double the mortality rates seen in wealthier ones.
Access to diagnostics, specialist care and lifesaving procedures varies sharply across the continent. Women are still less likely to receive some key cardiac interventions, while air pollution is worse in poorer countries and obesity, diabetes and hypertension remain widespread.
These figures make the case for a serious European response. The EU’s forthcoming Safe Hearts Plan could be an important step in that direction, but it will only be useful if it reflects the complexity of the problem it is trying to solve. That means resisting the temptation to turn cardiovascular policy into another campaign against ultra-processed foods.
A category that conceals as much as it reveals
Diet is one of several factors that can influence cardiovascular health. Public-health guidance commonly encourages the consumption of fruit, vegetables, pulses and whole grains, while recommending moderation in the intake of sugary drinks and red and processed meat. These are established elements of the wider conversation around healthy eating.
But the current debate increasingly reaches for a broader and much less precise category: ultra-processed foods, or UPFs. The term is often used as though it describes a clearly defined group of uniformly harmful products. In reality, it can encompass everything from crisps and confectionery to canned beans, fortified bread, infant formula and some yoghurts. A category this broad risks obscuring more than it clarifies.
Recently, a European Society of Cardiology consensus statement advised heart patients to cut back on UPFs and favour home-cooked meals. While well-intentioned, this is too blunt an approach to a complex public-health challenge. Treating UPFs as a single category to be avoided risks vilifying a wide range of foods without adequately accounting for their nutritional differences or the practical role they can play in people’s diets. It also overlooks the reality that cooking from scratch is not equally feasible for everyone, and that convenience should not be treated as a failure of personal responsibility.
For a family juggling shift work, long commutes or caring responsibilities, a tin of vegetables, a jar of sauce or a frozen meal may make the difference between eating something adequate and skipping a proper meal altogether. Longer shelf lives matter for people on tight budgets. So do affordability, access and the ability to store food safely. A debate that fails to acknowledge those realities risks drifting away from the circumstances in which people actually live.
Not all processed foods are the same
A recent discussion in Estonia makes the point in a different way. Public-health doctor Taavi Tillmann argued that people should eat far more plant-based food and reduce their consumption of red and processed meat. He criticised sugary drinks and products designed to encourage overconsumption. But his argument was not that every form of processing is equally damaging.
The important question was what people are eating, not whether every product has passed through a factory.
That distinction is important. Foods that fall within the broad category of processed or ultra-processed products can differ considerably in their nutritional composition, purpose and role within a balanced diet.
The science is not as straightforward as some headlines imply, either. Much of the research linking high UPF consumption to poor health outcomes is observational. That does not make it irrelevant, but it does mean that association should not automatically be treated as proof of causation. The definitional problems are also considerable. Different classification systems do not always identify the same products, and consumers themselves often struggle to understand what the term “ultra-processed” actually means.
The inequalities behind the statistics
There is a further danger in the current fixation on UPFs: it can allow governments to avoid the harder questions. The ESC Atlas report makes clear that cardiovascular health is shaped by far more than individual food choices. Pollution levels, income, access to doctors, early screening, prevention services and the availability of safe spaces for physical activity all play a role. The same is true of working conditions, education and the design of cities.
A person cannot follow lifestyle advice in a vacuum. It is easier to tell people to cook more often than it is to address food poverty, long working hours or poor public transport. It is easier to issue dietary warnings than to invest in preventive healthcare or tackle the uneven distribution of specialist services across Europe. Yet those are precisely the questions a credible heart-health strategy should confront.
The ESC’s own findings point to the scale of the challenge. Cardiovascular outcomes remain sharply divided along economic and geographic lines, while women continue to face disadvantages in access to care. These are not marginal issues. They are central to understanding why some people develop heart disease earlier, receive treatment later or live with poorer outcomes.
A broader approach to heart health
The Safe Hearts Plan should therefore avoid substituting one simplistic message for a serious prevention strategy. Better school meals, stronger local health services and wider access to screening would all be worthwhile. So would investment in active travel, public spaces and community-level prevention.
Personalised nutritional support also has a role to play. Advice that takes account of age, income, medical history and cultural habits is more likely to improve health than blanket warnings that divide food into virtuous and suspect categories. Public-health policy works best when it gives people realistic options rather than setting standards many cannot meet.
Europe’s cardiovascular crisis deserves urgency, but urgency should not be confused with oversimplification. The problem is not that people have failed to follow the latest dietary instruction. It is that too many people still live in conditions that make good heart health harder to achieve. A serious Safe Hearts Plan would begin there.
Photo by Patty Brito on Unsplash
