A Public Health Action Plan to Prevent Heart Disease and Stroke

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The Challenge

Despite the major progress in reducing death rates from heart disease and stroke, their total impact has increased in the past 50 years according to many health status indicators.^1,6 In the United States, growing numbers of people are dying from these conditions or surviving with disability, dependency, and high risk for recurrence. During the 1990s, although the overall death rate for these conditions declined 17.0%, the actual number of deaths increased 2.5%. This reflects, in part, growth in the population over age 65, which has the highest rates and therefore contributes most to the mounting numbers of deaths each year.⁷ 

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As a result, heart disease remained the nation's leading cause of death in 2000 for women and men and for nearly every racial and ethnic group. Stroke is the third leading cause of death, and both conditions are major causes of disability for people 65 and older, as well as for many younger adults. Thus, the importance of these conditions is not restricted to the older population, though the number of victims at older ages are especially great. Risk factors such as diabetes have increased sharply, even for younger people.⁸ Growing health disparities place certain populations, especially racial or ethnic minorities and people of low income or education, at excess risk relative to groups with the most favorable rates of heart disease and stroke.^9–12 Aging of the baby boom generation portends a sharp rise by 2020 in the number of people who die from heart disease and stroke or survive with dependency.^3,4 

Clearly, heart disease and stroke contribute substantially to the nation's health care crisis, as addressed by Secretary of Health and Human Services Tommy G. Thompson in his initiative, Steps to a HealthierUS. This initiative places an important new emphasis on prevention of chronic diseases and conditions. The epidemic of heart disease and stroke can be expected to continue, with an increasing burden and widening disparities, unless unprecedented public health efforts are mounted to arrest and reverse it. This challenge will test the ability of public health institutions at all levels to fulfill their obligation to protect society against this rising epidemic. Three factors affect the current challenge. 

• Support for public health programs to prevent heart disease and stroke is low. State public health agencies expend less than 3% of their budgets on chronic disease programs, including heart disease and stroke prevention.⁷ 

• The costs of failure are very high. The economic costs of heart disease and stroke rise each year. These costs include the numbers of people requiring treatment for risk factors or early signs of disease; emergency treatment for first or recurrent episodes of heart attack, heart failure, or stroke; and efforts to reduce disability and prevent recurrent episodes. In 2003, health care costs alone are projected to be $209.3 billion. Although personal and societal costs are incalculable, they include another $142.5 billion in lost productivity.¹ These costs will escalate further if this epidemic is not halted and reversed. As noted by Secretary Thompson, chronic diseases and conditions, including heart disease, consume more than 75% of our nation's health care dollars, yet they are largely preventable. 

• An unprecedented opportunity to prevent heart disease and stroke exists today in the United States. We know what causes these conditions and how to prevent them, largely because of the decades of research supported by NIH, the American Heart Association, and others.⁶ Healthy People 2010 has outlined clear goals, and the Healthy People 2010 Heart and Stroke Partnership* was established to help in achieving them.⁵ Also, health professionals have become more aware of the need for immediate action as they increasingly recognize the continuing cardiovascular epidemic, recent unfavorable trends, and forecasts of a mounting disease burden.⁸

* Current partners include the American Heart Association/American Stroke Association, CDC, Centers for Medicare & Medicaid Services, Indian Health Service, NIH, and Office of Public Health and Science, U.S. Department of Health and Human Services.

Next Section: The Public Health Response

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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