WHO MONICA Project: What Have We Learned and Where to Go from Here?

The decline in infectious diseases and a rise in chronic diseases, particularly cardiovascular disease (CVD), underlies the health trajectory of the 20th century. While much was known about CVD, particularly myocardial infarction and stroke, population data were problematic. Importantly, the peak and decline of the CVD epidemic in the 1960s and 1970s in some countries was not well recognized, leading to calls for more population-based disease surveillance. The WHO Multinational MONItoring of Trends and Determinants in CArdiovascular Disease (MONICA) Project was the most comprehensive approach to better understanding disease etiology, incidence and trends at the population level. For a period of ten years or more in each center, from the early 1980s to the mid 1990s, MONICA implemented CVD surveillance in 21 countries. It included mortality, morbidity, coronary care, and population-based risk factor surveillance. The study is characterized by well-described methods and high quality data. The findings show large differences between different centers in 21 countries and provide information for disease treatment and prevention. Many MONICA centers continued to actively collect data on populations within their countries. This experience provides a comprehensive approach for CVD patterns in the developed countries and the oncoming epidemic in the developing world.