A Public Health Action Plan to Prevent Heart Disease and Stroke

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Section 1. Heart Disease and Stroke Prevention: Time for Action

The Present Opportunity

To be effective, public health action must have a solid knowledge base that is built on science and practical experience and sound policies that are founded on this knowledge. Over the past 30 years, such support for heart disease and stroke prevention has been greatly strengthened. But this support has not been sufficient to establish and sustain the needed public health effort. Until the early 1970s, the Bureau of State Services in the former U.S. Department of Health, Education, and Welfare supported state health departments through its Heart Disease and Stroke Control Program, but that program was discontinued. And although the Inter–Society Commission on Heart Disease Resources called for a national commitment to prevent atherosclerosis in the early 1970s, public health efforts to address these problems have remained too limited to offer the full potential benefit of existing knowledge.²⁷ 

What is different now from those early transient efforts? What new and unprecedented opportunities exist for heart disease and stroke prevention? This Action Plan describes the current opportunities for action and the potential for success in the immediate future. Recent trends in the CVD burden in the United States and projections of the continuing predominance of heart disease and stroke as causes of death and disability worldwide have motivated concerned health professionals to consider a new level of concerted action to prevent CVD.^4,5 Clearly, treating victims of heart disease and stroke cannot alone solve the problem. Prevention is preferable in principle and necessary as a matter of national policy if we are to attain our goals of increasing quality and years of healthy life and eliminating health disparities. This perspective has recently been strongly reinforced by Steps to a HealthierUS, a bold new initiative by Secretary of Health and Human Services Tommy G. Thompson. The Steps initiative is designed to address this nation's health care crisis and the need to prevent the chronic diseases and conditions, including heart disease and stroke, that represent 75% of our health care expenditures. The Secretary's initiative is a response to President George W. Bush's HealthierUS initiative, which directs key departments of the federal government to develop plans to better promote fitness and health for all Americans. 

To implement Steps to a HealthierUS, the U.S. Department of Health and Human Services (HHS) is marshalling all available resources within the department and calling on other federal agencies and the private sector (e.g., the fast food and soft drink industries) to take steps to improve our nation's health. At the personal level, all Americans are challenged to take the first step by walking 30 minutes a day. At the societal level, policy makers are asked to take their first step by embracing prevention as the long–term solution for our health care crisis. The Steps initiative thus constitutes a significant impetus toward prevention, which is strongly supported by this Action Plan. 

The breadth of the 2010 goal for preventing heart disease and stroke calls attention to the wide range of opportunities for intervention— both to prevent CVD through primary and secondary prevention and to promote CVH. This goal also underscores the increased role for public health agencies, including CDC. As population–wide approaches become more common, the skills and resources of public health agencies at all levels of government will be increasingly called upon.

In recent years, it has also been realized that effective, concerted action requires partnerships with familiar organizations and agencies, as well as with nontraditional partners with distinct perspectives and contributions. As a result, new alliances are being formed, and new ideas, expertise, and resources are being shared. The Healthy People 2010 Heart and Stroke Partnership is a good example of this type of partnership, which can potentially include partners within and beyond the health sector. Already, channels of communication have been opened that will help identify common areas of interest and opportunities for synergy among these national organizations and agencies. Additional agreements between federal agencies and other organizations further illustrate the development of key partnerships in CVH.

Recent advances in knowledge heighten confidence that public health intervention can improve on our CVD forecast for the next two decades. For example, researchers demonstrated that high blood pressure can be prevented with dietary interventions.³⁵ We now know that diabetes can be prevented or delayed with dietary and physical activity interventions.³⁶ And recent findings strongly suggest that by preventing CVD risk factors from emerging in adolescence and early adulthood, we can expect to prevent atherosclerosis later in life.²⁰ Evidence that blood cholesterol and blood pressure levels are improving in the population reinforce the belief that positive changes are occurring and can be accelerated, even while adverse changes (e.g., the obesity and diabetes epidemics) call for more innovative approaches to reverse these alarming trends.^37,38 

The health of this nation is the central focus of the Action Plan, but not to the exclusion of concern for the global dimensions of the burden of heart disease and stroke and recognition of the potential value of international collaboration in their prevention. The Global Burden of Disease Study, cited earlier, stated that heart disease and stroke were the foremost causes of death throughout the world in 1990 and projected that they will remain so in 2020.⁵ In its 1999 report, Impending Global Pandemic of Cardiovascular Diseases, the World Heart Federation provides extensive documentation of this epidemic, as well as resources and strategies by which to address it.³⁹ 

In the same year, the Director–General of the World Health Organization presented a report titled, Global Strategy for the Prevention and Control of Noncommunicable Diseases, which noted that, "Four of the most prominent noncommunicable diseases—cardiovascular disease, cancer, chronic obstructive pulmonary diseases and diabetes—are linked by common preventable risk factors related to lifestyle. These factors are tobacco use, unhealthy diet and physical inactivity . . . Intervention at the level of the family and community is essential for prevention because the causal risk factors are deeply entrenched in the social and cultural framework of the society. Addressing the major risk factors should be given the highest priority in the global strategy for the prevention and control of noncommunicable diseases."⁴⁰ 

A major contribution toward this end is The World Health Report 2002: Reducing Risks, Promoting Healthy Life.⁶ This report presents an extensive analysis of the major risk factors and the potential impact of their prevention and control on the burden of cardiovascular and other chronic diseases throughout the world. The report notes, "In order to protect people—and help them protect themselves—governments need to be able to assess risks and choose the most cost–effective and affordable interventions to prevent risks from occurring."⁶ Significant advances in approaches and methods for such an assessment are offered by that report. 

Does this nation have a role in the global arena of heart disease and stroke prevention? Addressing this question, the Institute of Medicine's 1997 report, America's Vital Interest in Global Health, concluded that "...the United States should build on its strengths and seize the unprecedented opportunities to work with its international partners to improve health worldwide."⁴¹ Proposed action areas included biomedical research and development, education and training in the health sciences, and effective international cooperation. An underlying premise of the report was that "global health problems affect all peoples in all countries and transcend national boundaries, levels of development, and political systems."⁴¹ A sequel to this report, Control of Cardiovascular Diseases in Developing Countries: Research, Development, and Institutional Strengthening, appeared in 1998 and recommended specific steps to be taken to assess the burden, develop intervention plans, and take effective action country by country.⁴² At the same time, it was noted that, "Many organizations and programs are engaged in activities relevant to CVD prevention and control. The impact of their work can be enhanced, and duplication avoided, by effective exchange of information on CVD activities."⁴² 

These recent reports, which have documented the global problem of CVD and the growing recognition of its worldwide importance, strongly suggest that this nation does have a role in the global arena of heart disease and stroke prevention. This role includes providing information from our own experiences to support the work of others and gaining from their growing knowledge and experience in return. Another basis for this view stems from the position of HHS, which is conducting and supporting programs to advance global health issues, including policy development, public health infrastructure strengthening, scientific research and research training, and tobacco control (see (www.hhs.gov/news/press/2002pres/global.html). The recommendations of this Action Plan for engaging in regional and global partnerships for heart disease and stroke prevention are in full accord with this view. 

The challenging circumstances we face today, in combination with significant advances in research, provide strong justification for developing a public health action plan to prevent heart disease and stroke. In response, this Action Plan has been developed. If effectively implemented, this plan can arrest or reverse the epidemic of heart disease and stroke in the United States and contribute substantially to preventing these conditions throughout the world.

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Date last reviewed: 05/12/2006
Content source: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion