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A
Public Health Action Plan to Prevent Heart Disease and Stroke
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Section 2. A Comprehensive Public Health Strategy and the Five Essential
Components of the Plan: A Platform for Action
Five
Essential Components of the Action Plan
The third requirement for
a comprehensive public health strategy is defining the action areas in which
recommendations are needed. An independent Expert Panel was convened to
address each of five components considered essential to this plan—taking
action, strengthening capacity, evaluating impact, advancing policy, and
engaging in regional and global partnerships. Each component is best
characterized by brief statements from the five panels, indicating their
perspective on their charge and the theme of the resulting recommendations.
The linkages of these five components form an integrated plan (see Figure 2
in Overview). Each panel's recommendations
are presented in Section 3. Details of
the planning process and the premises that guided each panel's work are
outlined in Appendix D.
- Taking action:
Putting present knowledge to work (Expert Panel A).
Perspective:
Acting now on what is already known must be the first priority. The
greatest need is to implement the most promising policies and programs for
heart disease and stroke prevention immediately and to the fullest extent
feasible. Effective communication and innovative leadership, partnerships,
and organizational arrangements are required.
Theme:
Federal, state, and local public health agencies urgently need explicit
mandates and adequate resources to effectively implement policies and
programs to prevent chronic diseases and to arrest and reverse the
continuing national epidemic of heart disease and stroke.
- Strengthening
capacity: Transforming the organization and structure of public health
agencies and partnerships (Expert Panel B).
Perspective:
Effective action to prevent heart disease and stroke requires
transformation in how public health agencies are organized. Strengthening
the competencies and resources of the public health workforce for the
needed tasks and managing the development, maintenance, and dynamic growth
of effective partnerships are necessary for this change.
Theme:
Public health agencies must develop and maintain new capacities, including
organizational arrangements and competencies for CVH promotion and CVD
prevention. They also need networks of established and innovative
partnerships to fulfill their mandates to prevent heart disease and
stroke.
- Evaluating impact:
Monitoring the disease burden, measuring progress, and communicating
urgency (Expert Panel C).
Perspective:
Action must be guided by 1) continuous, comprehensive assessment of all
aspects of the public health burden of CVD; 2) identification of
opportunities for effective intervention; and 3) prediction and evaluation
of the impact of actions taken. At present, essential information for
planning and evaluation is often unavailable for priority populations or
the population as a whole. The needed data include key indicators of
social and environmental conditions; patterns of behavior; incidence and
prevalence of risk factors, as well as the status of their detection,
treatment, and control; and incidence of first and recurrent CVD events,
case fatality, hospitalization, mortality, disability, and survival. Data
sources must be enhanced and used more effectively for assessment, policy
development, and assurance at local, state, and national levels. Major
gaps in data systems must be closed (e.g., by monitoring incidence of risk
factors and events), workforce needs must be met (e.g., for data
collection, analysis, interpretation, reporting, and dissemination), and
new data sources must be established (e.g., to expand coverage of
populations at high risk and establish a network of sentinel communities
for comprehensive population-based monitoring and surveillance).
Theme: To
guide and document progress toward national goals for heart disease and
stroke prevention, public health agencies at all levels must establish and
maintain substantially improved systems of data collection, analysis, and
reporting. These systems must meet requirements for monitoring key
Healthy People 2010 leading health indicators, evaluating the impact
and effectiveness of policies and programs, and communicating this
information rapidly. All such systems must conform to the highest
standards of data quality and reliability.
- Advancing policy:
Defining the issues and finding the needed solutions (Expert Panel D).
Perspective:
The effectiveness of actions taken to prevent heart disease and stroke
in coming years can increase as the foundation of evidence–based public
health decision making is strengthened. A well–developed and continually
updated agenda for CVD prevention research will support this growth. This
research agenda must address critical policy issues through targeted
investigations and scientific oversight; potential research settings,
funding mechanisms, and evaluation plans require attention as well.
For example, if
atherosclerosis and high blood pressure (major causes of heart disease and
stroke) were prevented by interventions that promote healthy lifestyles
and environments in youth and throughout adulthood, such efforts would
greatly reduce the risk of the current school–aged generation for
developing CVD. Testing this hypothesis and others related to CVH
promotion and CVD prevention depends on research that is strongly
supported, effectively implemented, and adequately sustained. Although
current knowledge provides a solid base for policy and practice, more
research is needed. Methods for translating existing knowledge into
practice must be improved; current and proposed policies and programs that
create a demand and opportunity for healthy lifestyles must be evaluated;
and new data, especially on social and environmental determinants of CVD,
must be collected. These areas correspond closely to the U.S. Department
of Health and Human Services priority area of Preventing Disease, Illness,
and Injury (Priority X of the Research Themes and Priority Research
Areas).8
Theme: A
prevention research agenda for heart disease and stroke must be developed
and fully implemented to rapidly expand the nation's ability to translate
existing knowledge into practice, while continually providing new
knowledge to advance public health policy and create more effective
programs.
- Engaging in
regional and global partnerships: Multiplying resources and
capitalizing on shared experience (Expert Panel E).
Perspective:
Regional and global partnerships in heart disease and stroke prevention
present important opportunities for collaboration, as described in Section 1. Contribution of material
and nonmaterial resources developed in the United States can be used to
benefit global prevention efforts. Communicating closely with regional and
global partners regarding their experiences with policies and programs in
diverse settings will be beneficial to all and will return high dividends
on investment. Contributions of research in other countries to policy
development in the United States are illustrated in Section 1. The threat that CVD poses
to human life is important nationally and globally, especially in poorer
countries. The widespread occurrence of CVD in countries undergoing social
and economic transitions, the unaddressed needs related to CVD prevention,
and the need for expanded use of early intervention approaches that are
largely unfamiliar all underscore the value of global cooperation.
Theme: As
action to prevent heart disease and stroke gains momentum globally, the
United States must engage with regional and global partners to support
their efforts and to gain from the resulting worldwide growth of knowledge
and practical experience.
- Linking the
components: Integrating the parts and forging a plan (All Expert
Panels and the Working Group).
Taking action
will be limited initially by the capacity of public health agencies
and partners to undertake the work on the scale required.
Strengthening capacity will enable them to increase the range and
intensity of action. Evaluating impact will contribute to
development of more effective policies and programs, improved
identification of best practices, and more rapid communication of new
information to the public and policy makers. This activity will increase
support for the first two components. Advancing knowledge
through prevention research will accelerate policy development by
supporting critical investigations on policy–related issues and by
contributing to better ways to disseminate effective programs widely.
Prevention research will become more common as research capacity is
strengthened, data systems for surveillance and evaluation are improved,
and policy makers increasingly recognize the value of such research.
Regional and global partnerships will contribute to progress in
each of the other four components through the shared experience of global
partners who are addressing similar issues.
Theme:
Implementation of the plan must assure integration of all five components
in a coordinated approach that recognizes and strengthens the potential
linkages among them. Such integration and coordination are critical to
effective implementation of the plan.
Next Section: References
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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 |
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