2008 Public Health Action Plan Update: Celebrating Our First Five Years

Action Plan Return to Action Plan Main Page  Sections Overview Milestones/Landmark Events Key Messages Action Plan: Celebrating 5 Years Reflections from the Chair of the Forum Commentary from AHA Commentary from ASTHO Commentary from NACDD and CHC Reducing Heart Disease and Stroke in the U.S. Burden and Disparities Today Making Connections Mission Statements/Strategies Review of  Components and Recommendations Action Framework Implementation Group's Priorities for 2008/2009 Appendix A Appendix B

A Review of the Essential Components and Recommendations of A Public Health Action Plan to Prevent Heart Disease and Stroke by the National Forum's Implementation Groups

This section contains the seven Implementation Groups’ suggested updates to A Public Health Action Plan to Prevent Heart Disease and Stroke (Action Plan). These suggestions are based on the current environment for heart disease and stroke prevention activities around the world. Any new recommendation, action step, or expected outcome is indicated by “(NEW).”

Each Implementation Group’s section concludes with the activities selected by that Group as priorities to be undertaken on behalf of the National Forum in 2008–2009.

The table below explains where material related to each Implementation Group appears in the Action Plan.

1. Communications Implementation Group

Chair: Michael Greenwell
Vice Chair: Brian Bilchik
Members: Kristen Betts; Catherine Coleman; Marian Emr; Diane Mulligan Fairfield; Suzanne Folkes; Crystelle Fogle; James Galloway; Judy Hannan; Angela Hedworth; Marsha Houston

MISSION

To effectively communicate the urgency and importance of preventing heart disease and stroke through a long-term strategy of public information and education.

The following contains the Communications Implementation Group’s suggested updates to recommendations in A Public Health Action Plan to Prevent Heart Disease and Stroke (Action Plan). These suggestions are based on the current environment for heart disease and stroke prevention activities around the world. New recommendations, action steps, and expected outcomes are indicated by “(NEW).” Please refer to the Action Plan for the original Recommendation and Action Steps and Expected Outcomes.

The Communications Implementation Group’s priority Recommendation, Action Step, and Expected Outcome to be undertaken on behalf of the National Forum in 2008–2009 are given at the end of the Group’s list of updates.

RECOMMENDATION

The urgency and promise of preventing heart disease and stroke and their precursors (i.e., atherosclerosis, high blood pressure, and their risk factors and determinants) must be communicated effectively by the public health community through a new long-term strategy of public information and education. This new strategy must engage policy makers and other stakeholders at the global, national, state and local levels. As a matter of emphasis, special consideration must be paid to those most at risk. Communication strategies should utilize the most current forms of available technology as well as those communications devices that are accessible in various communities in the United States and around the world.

Action Step: Assess requirements for effective messages. Set the agenda for a long-term, national public information strategy that conveys the importance and feasibility of prevention. Craft clear and compelling messages that capture public attention, help people understand cardiovascular health (CVH) and its risks, and support healthy behavioral changes. Include a social marketing strategy to identify audiences, develop effective national messages, and determine media avenues (e.g., peer-reviewed journals, CDC’s Morbidity and Mortality Weekly Report, community report cards). Communicate consistent CVH information and messages to the public, health professionals, and policy makers.

Expected Outcome: Communication needs and opportunities are assessed and used to guide initial development of the long-term public information strategy anticipated by the Action Plan. Key messages for the National Forum are refined and are being incorporated into all communications vehicles.

Action Step: Communicate effectively at global, national, and state levels to gain consensus on messages and create public demand for heart-healthy options to prevent heart disease and stroke. Work with partners whose roles include education of key stakeholders. Engage local, state, national, and international policy makers, including new stakeholders.

Expected Outcome: Multiple audiences are identified and reached with consistent CVH information and messages. Exposures are targeted and repetitive. Reach and maintain critical intensity, neutralize negative messages from special interests, and include expression in popular humor as a measure of public awareness and interest. An effective and sustained communication program exists and is developing appropriate public messages about CVH.

Action Step: Collect information and monitor research systematically from global, national, state, and local levels to facilitate sharing of knowledge and experience in developing educational campaigns as part of this continuing strategy.

Expected Outcome: Public health agencies are promoting continuing development of appropriate educational materials.

Action Step (NEW): Develop communication strategies to effectively communicate with those populations most at risk and address inequities in access to health care.

Expected Outcome (NEW): Information and messages are tailored specifically to impact populations most at risk by creating public health materials in different languages and identifying and utilizing communications channels in at-risk communities.

Action Step (NEW): Identify communication materials that have been created by other partners, and determine whether these materials can be modified for national or global usage.

Expected Outcome (NEW): The National Forum for Heart Disease and Stroke Prevention is established as a credible clearinghouse for CVH information.

Action Step (NEW): Understand the changing dynamics of communication and the increasingly interactive nature of communications. Incorporate electronic (Web-based) forms of communication in strategies. In outreach to different international communities, identify and use communications devices that are accessible in a particular community.

Expected Outcome (NEW): A digital communications strategy has been developed for the National Forum that includes the launch of a Web site, socializing the Web site usage among the National Forum membership, and using the Web site to promote National Forum priorities.

Action Step (NEW): Constitute the Communications Implementation Group of the National Forum to represent organizations and individuals from all aspects of communications practice and technology.

Expected Outcome (NEW): A well-staffed Communications Implementation Group has been built that represents organizations and individuals from all aspects of communications practice and technology.

2008–2009 Priority

RECOMMENDATION

The urgency and promise of preventing heart disease and stroke and their precursors (i.e., atherosclerosis, high blood pressure, and their risk factors and determinants) must be communicated effectively by the public health community through a new long-term strategy of public information and education. This new strategy must engage policy makers and other stakeholders at the global, national, state and local levels. As a matter of emphasis, special consideration must be paid to those most at risk. Communication strategies should utilize the most current forms of available technology as well as those communications devices that are accessible in various communities in the U.S and globally.

Action Step:  Assess requirements for effective messages. Set the agenda for a long-term, national public information strategy that conveys the importance and feasibility of prevention. Craft clear and compelling messages that capture public attention, help people understand cardiovascular health (CVH) and its risks, and support healthy behavioral changes. Include a social marketing strategy to identify audiences, develop effective national messages, and determine media avenues (e.g., peer-reviewed journals, CDC’s Morbidity and Mortality Weekly Report, community report cards). Communicate consistent CVH information and messages to the public, health professionals, and policy makers.

Expected Outcome: Key messages for the National Forum are refined and are being incorporated into all communications vehicles.

2. Public Health Leadership Implementation Group

Chair: James Baranksi
Vice Chair: B. Waine Kong
Members: Erin McDonald Bicknell; Ivonne Fuller-Bertrand; Margaret Casey; Jay Glasser;
Dyann Matson-Koffman; Tim LaPier; Debra Wigand

MISSION

To foster effective leadership and partnership for preventing heart disease and stroke.

The following contains the Public Health Leadership Implementation Group’s suggested updates to recommendations in A Public Health Action Plan to Prevent Heart Disease and Stroke (Action Plan). These suggestions are based on the current environment for heart disease and stroke prevention activities around the world. New recommendations, action steps, and expected outcomes are indicated by “(NEW).” Please refer to the Action Plan for the original Recommendation and Action Steps and Expected Outcomes.

The Public Health Leadership Implementation Group’s priority Recommendation, Action Steps, and Expected Outcomes to be undertaken on behalf of the National Forum in 2008–2009 are given at the end of the Group’s list of updates.

RECOMMENDATION

The nation’s public health agencies, their partners, and the public must provide the necessary leadership for a comprehensive public health strategy to prevent heart disease and stroke.

Action Step: Broaden, strengthen, and sustain public health partnerships as an essential force for implementing and institutionalizing the plan. Include public health agencies at all levels (national, state, and local) and a range of other federal, state, and local agencies (e.g., education, agriculture, transportation, housing, environment, tribal organizations); private organizations (e.g., faith–based organizations, business, labor, media, foundations); and academia (e.g., schools of public health, departments of preventive and community medicine, family practice, pediatrics, internal medicine, geriatrics).

Expected Outcome: Partnerships supporting the plan are strengthened or established, forming an inclusive array of interests representing all relevant sectors of society.

Action Step: Convene agencies at all levels to help develop implementation plans at state and local levels.

Expected Outcome: National, state and local public health officials, federal health care systems, and tribal organizations are convened to help implement the plan.

Action Step: Continue to encourage state health departments to foster internal and external partnerships and collaborations with complementary CVH–related programs. Allow flexible use of state and federal funding to facilitate these important links.

Expected Outcome: Support for CVH partnership activities is strengthened and technical assistance in partnership development and management is available to state and local public health agencies and other interested constituencies. Agencies have expanded the number and diversity of internal and external CVH collaborations. Available funds are used effectively to support coordination among programs.

Action Step: Explore and enhance the relationships public health agencies have with existing CVH policy coalitions and consider the need for additional partners to support the goals of the plan.

Expected Outcome: Existing CVH policy coalitions are strengthened.

Action Step (NEW): Establish and improve partnerships to develop, implement, and evaluate plans to address heart disease and stroke.

Expected Outcome (NEW): There is adequate representation of partners on planning groups; guidance is being provided for development and implementation of comprehensive state plans; partners are committing resources and sharing accountability for the state plan; the state plan is evaluated.

Action Step (NEW): Educate key decision makers to support heart disease and stroke prevention policies and programs.

Expected Outcome (NEW): The State Plan Index for Heart Disease and Stroke Prevention is finalized; the Resource Tool is finalized; marketing strategy to promote or enhance state partnerships and leadership is developed, and a training curriculum for persons to utilize the State Plan Index and Resource Tool to foster effective collaborations is developed; training is presented to select states and their partners on the State Plan Index and Resource Tool.

2008–2009 PRIORITY

RECOMMENDATION

The nation’s public health agencies, their partners, and the public must provide the necessary leadership for a comprehensive public health strategy to prevent heart disease and stroke.

Action Step: Establish and improve partnerships to develop, implement, and evaluate plans to address heart disease and stroke.

Expected Outcome: There is adequate representation of partners on planning groups; guidance is being provided for development and implementation of comprehensive state plans; partners are committing resources and sharing accountability for the state plan; the state plan is evaluated.

Action Step: Educate key decision makers to support heart disease and stroke prevention policies and programs.

Expected Outcome: The State Plan Index for Heart Disease and Stroke Prevention is finalized; the Resource Tool is finalized; marketing strategy to promote or enhance state partnerships and leadership is developed, and a training curriculum for persons to utilize the State Plan Index and Resource Tool to foster effective collaborations is developed; training is presented to select states and their partners on the State Plan Index and Resource Tool.

3. Action Priorities Implementation Group

Chair: William Caplan
Vice Chair: Jennifer Smith
Members: Katie Clark Adamson; Calvo Ahmed; Erin McDonald Bicknell; Jill Birnbaum;
Mara Krouse Donahue; Ron Finch; Bernadette Ford Lattimore; Kathy Gallagher; Jason Hsieh;
Ken LaBresh; Rian Landers; Debra Lightsey; Julia Pekarsky; Mark Schoeberl; Ron Todd

MISSION

To identify effective policies in cardiovascular health (CVH) promotion and cardiovascular disease prevention at the national, state, and local levels to ensure effective public health action against heart disease and stroke.

The following contains the Action Priorities Implementation Group’s suggested updates to recommendations in A Public Health Action Plan to Prevent Heart Disease and Stroke (Action Plan). These suggestions are based on the current environment for heart disease and stroke prevention activities around the world. New recommendations, action steps, and expected outcomes are indicated by “(NEW).” Please refer to the Action Plan for the original Recommendations and Action Steps and Expected Outcomes.

The Action Priorities Implementation Group’s priority Recommendation, Action Step, and Expected Outcome to be undertaken on behalf of the National Forum in 2008–2009 are given at the end of the Group’s list of updates.

RECOMMENDATION

Initiate policy development in CVH promotion and CVD prevention at national, state, and local levels to assure effective public health action against heart disease and stroke. In addition, evaluate policies in non-health sectors (e.g., education, agriculture, transportation, community planning) for their potential impact on health, especially with respect to CVD.

Action Step: Establish active collaboration among public health agencies, clinical preventive service providers, and other partners at all levels (e.g., purchasers of health care insurance, insurers, providers of care, health counselors, patient groups) to implement effective policies and programs that address CVH promotion and primary and secondary prevention of cardiovascular disease (CVD).

Expected Outcome: Through technical assistance, consultation, and cooperative arrangements, partners who deliver CVH promotion and CVD prevention programs and services at all levels are receiving active support and incentives. These partners are developing and implementing more effective policies that address the full spectrum of intervention approaches represented in the action framework in Section 2 and reflect current knowledge of the efficacy and safety of therapeutic interventions.

Action Step: Develop and regularly update simulation models to address the expected health and economic benefits to society from investing in heart disease and stroke prevention.

Expected Outcome: Comprehensive economic modeling of the CVD burden and the potential impact of preventive policies and programs is ongoing and supports policy development and implementation.

Action Step: Advocate for health impact assessments of national policies and provide a framework to states to conduct these assessments at the state level.

Expected Outcome: National, state, and local policies are regularly identified and subject to health impact assessments with specific attention to their potential effects on CVH and other chronic diseases of public health concern.

Action Step (NEW): Develop, implement, and update annually an advocacy plan for our priority policy areas (prevention of risk factors, chain of survival, quality-of-care, disparities, heart disease and stroke prevention programs in all 50 states).

Expected Outcome (NEW): Policies have been selected; actions are being taken on behalf of policies in accordance with an advocacy plan; policies are being passed or implemented.

RECOMMENDATION

Act now to implement the most promising public health programs and practices for achieving the four goals for preventing heart disease and stroke, as distinguished by the Healthy People 2010 Heart and Stroke Partnership based on the different intervention approaches that apply. These goals are prevention of risk factors, detection and treatment of risk factors, early identification and treatment of heart attacks and strokes, and prevention of recurrent cardiovascular events. Public health agencies and their partners must provide continuous leadership to identify and recommend new and effective interventions that are based on advances in program evaluation and prevention research and a growing inventory of “best practices.”

Action Step: Review, revise if appropriate, and rigorously apply criteria for identifying model programs. In the meantime, implement current programs and evaluate them against these criteria.

Expected Outcome: Criteria appropriate for identifying best practices in CVH promotion and CVD prevention are established and are being used. Programs considered the most promising are implemented as expeditiously as possible, with adequate provision for rigorously evaluating these programs in accordance with accepted criteria.

Action Step: Identify and disseminate information about model programs that include all elements of best practices for a population–based approach to CVH.

Expected Outcome: These criteria are applied continually to identify model CVH/CVD programs, especially those in which multiple components are coordinated and integrated for maximum impact. These model programs are being disseminated.

Action Step: Generate and test new intervention models by funding new demonstration projects. Share materials and experiences in order to continually develop, implement, and evaluate best practices.

Expected Outcome: Innovative demonstration programs are being funded and rigorously evaluated. The resulting experiences are communicated rapidly and effectively to facilitate program replication and dissemination.

RECOMMENDATION

Address all opportunities for prevention to achieve the full potential of preventive strategies. Such opportunities include major settings (schools, work sites, health care settings, communities, and families), all age groups (from conception through the life span), whole populations — particularly priority populations (based on race/ethnicity, sex, disability, economic condition, or place of residence), and integration of chronic disease programs, conditions and risk factors.

Action Step: Develop, implement, and evaluate programs to address opportunities for CVH promotion and CVD prevention in the full array of multiple settings (e.g., schools, work sites, health care settings, other community sites) during all life stages (gestation; infancy and childhood; adolescence; and early, middle, and late adulthood), and among all priority populations (as defined by excessive health burdens or needs).

Expected Outcome: A matrix of settings, life stages, and at–risk populations is developed and disseminated as a tool for identifying policy and program needs and opportunities. Model policies and programs to address the demonstrated needs and opportunities are identified (or developed) and evaluated. These model policies and programs are disseminated for implementation at national, state, and local levels.

RECOMMENDATION

Emphasize promotion of desirable social and environmental conditions and favorable behavior patterns in order to prevent the major CVD risk factors and assure the fullest attainable accessibility and use of quality health services for people with risk factors or CVD. These actions are integral to a comprehensive public health strategy for CVH promotion and CVD prevention.

Action Step: Foster accountability of public health agencies for collaboration with their partners and engagement with society as a whole for addressing the full spectrum of opportunities to prevent heart disease and stroke as part of a comprehensive public health strategy.

Expected Outcome: CVH programs are recognized as having responsibility and accountability for a comprehensive public health strategy that addresses the full array of approaches to CVH promotion and CVD prevention, to help achieve the four Healthy People 2010 Heart and Stroke Partnership goals for preventing heart disease and stroke.

Action Step: Collaborate with partners in related fields (e.g., nutrition, physical activity, tobacco control, substance abuse), including those working to detect and treat risk factors (e.g., hyperlipidemia, high blood pressure, smoking, diabetes, obesity). Support programmatic activities in schools, worksites, health care settings, and community sites for priority populations.

Expected Outcome: The needed partnerships and collaborations are in place at national, state, and local levels to support these activities.

Action Step: Establish or strengthen collaborations with the Centers for Medicare and Medicaid Services, the National Committee for Quality Assurance, and other partners positioned to improve access to and use of high-quality care for patients with or at risk for CVD.

Expected Outcome: Partnerships are strengthened or established with the full array of organizations and agencies committed to effectively delivering high-quality health services (including preventive services) as part of a comprehensive public health strategy.

2008–2009 PRIORITY

RECOMMENDATION

Initiate policy development in CVH promotion and CVD prevention at national, state, and local levels to assure effective public health action against heart disease and stroke. In addition, evaluate policies in non-health sectors (e.g., education, agriculture, transportation, community planning) for their potential impact on health, especially with respect to CVD.

Action Step: Develop, implement, and update annually an advocacy plan for the APIG priority policies (Prevention of Risk Factors, Chain of survival, Quality-of-Care, Disparities, Heart Disease and Stroke Prevention programs in all 50 states).

Expected Outcome: Policies have been selected; actions are being taken on behalf of policies in accordance with an advocacy plan; policies are being passed or implemented.

4. Organizational Capacity Implementation Group

Chair:  Joan Ware
Vice Chair:  Libby Puckett
Members:  J. Nell Brownstein; Linda Faulkner; Gary Myers; Marcus Plescia; Linda Redman

MISSION

To build the capacity of federal, state, and local public health agencies, including laboratories, to address heart disease and stroke as a priority within a strong chronic disease prevention effort and to develop the needed competencies and resources.

The following contains the Organizational Capacity Implementation Group’s suggested updates to recommendations in A Public Health Action Plan to Prevent Heart Disease and Stroke (Action Plan). These suggestions are based on the current environment for heart disease and stroke prevention activities around the world. New recommendations, action steps, and expected outcomes are indicated by “(NEW).” Please refer to the Action Plan for the original Recommendations, Action Steps, and Expected Outcomes.

The Organizational Capacity Implementation Group’s priority Recommendations, Action Steps, and Expected Outcomes to be undertaken on behalf of the National Forum in 2008–2009 are given at the end of the Group’s list of updates.

RECOMMENDATION

Advocate for and assure public health infrastructure that supports and is accountable for chronic disease prevention and control programs at the federal, state and local levels, including laboratory components.

Action Step: Transform public health agencies at all levels so they can effectively prevent heart disease and stroke.

Expected Outcome: Public health agencies throughout the nation are undergoing the changes needed to expand their roles and meet the new challenges and opportunities of preventing heart disease and stroke and other chronic conditions of public health concern.

Action Step: Establish or strengthen identifiable heart disease and stroke prevention (HDSP) units in public health agencies at all levels. These units should be able to effectively reach all communities and have all necessary capacities for preventing heart disease and stroke, including new competencies in policy, environmental, and systems-level change. They should support population-wide health promotion and behavioral change for risk factor prevention and detection and management of risk factors.

Expected Outcome: Every state and territorial health agency has an identifiable unit or locus of responsibility for HDSP policy and programs. These agencies are able to provide support and assistance in HDSP activities to all local health agencies within their jurisdictions. Through increased and creative collaborations, public health agencies and their partners are strengthening their efforts to promote CVH and prevent risk factors and first or recurrent CVD events.

Action Step (NEW): Assist public health agencies in developing public-private partnerships with laboratory-related organizations and professional societies to support public health efforts to reduce the burden of heart disease and stroke through identification and monitoring of those persons at greatest risk.

Expected Outcome (NEW): Laboratory-related organizations and professional societies are collaborating with public health agencies in support of efforts to reduce the burden of heart disease and stroke through monitoring and identification of those most at risk.

RECOMMENDATION

Facilitate and promote training resources to develop and maintain appropriately trained public health workforces at national, state, and local levels. These workforces should have all necessary competencies to bring about policy, environmental, and systems changes and implement programs to improve CVH and decrease the heart disease and stroke burden, including laboratory requirements.

Action Step: Assure the development of training resources, including technical assistance and materials, to enable states to train staff in state and local health departments and in partner organizations and agencies, assuring that they have core competencies and meet performance standards for HDSP. These include changes in organizational structure, skills in incorporating best practices, and assurance of partnership effectiveness.

Expected Outcome: A comprehensive HDSP training function is developed and coordinated among all interested parties, providing a resource for state and local health agencies.

Action Step: Assure training in the following set of skills, which are essential to an effective public health workforce:

• Developing and maintaining partnerships and coalitions.
• Promoting community mobilization for effective action.
• Using health communications effectively.
• Defining and identifying the burden and status of chronic diseases.
• Preventing and managing risk factors.
• Formulating and executing policy, environmental, and systems approaches to intervention.
• Implementing, managing, and evaluating effective prevention programs.
• Leading diverse community organizations.
• Conducting culturally appropriate interventions targeted to priority populations.
• Using sound business practices and strategic planning (NEW).
• Strengthening knowledge and skills for laboratory testing of cardiovascular disease biomarkers (NEW).

Expected Outcome: Model curricula and educational programs (e.g., Web–based, video training packages) are available, including those needed for developing nontraditional skills. Trainees are meeting established goals.

Action Step: Consider a variety of options for training personnel. Possibilities include the following:
• Schools of public health and other professional schools in health fields.

• Train-the-trainer programs (e.g., in the use of data for health planning, health promotion, primary and secondary prevention, program planning, and evaluation, including population based interventions).
• A certificate program in HDSP.
• HDSP training at Prevention Research Centers.
• HDSP training programs with standard curricula.
• An expanded year-round program implemented with state and local health agencies.
• Joint school health/public health courses.
• Regional networks for education and training.
• Internet training programs.
• Continuing education, including training in information technology.
• A certificate program for lipidology offered by the National Lipid Association.
• Audio conferences and web training in laboratory issues offered by laboratory organizations and professional societies (NEW).

Expected Outcome: Training programs for HDSP public health personnel are identified. State and regional networks for HDSP training and education are established to coordinate training needs with available resources.

Action Step: Involve numerous partners, such as directors of state chronic disease programs, voluntary associations, and academic institutions, in the development of training programs. Examples of such activities include the following:

• Allow all state and local health agencies access to training and development opportunities, information, and materials regardless of their funding status.
• Provide state and local health personnel and partners access to professional development opportunities.
• Tailor training programs to the concerns, interests, and needs of local, state, and national constituents, and to the requirements of funders.
• Provide training in chronic disease prevention to personnel from diverse organizations, including governmental agencies, public health, schools of public health, and non-governmental health organizations.

Expected Outcome: Model education and training programs are being developed and disseminated to state and local health agencies and partners.

Action Step (NEW): Utilize the National Forum’s Web site and links to other appropriate Web sites to establish a clearinghouse for training opportunities and other resources related to the assessment and improvement of program capacity and competencies, and voluntary accreditation related to heart disease and stroke prevention. This will include the identification and sharing of best practices and state success stories.

Expected Outcome (NEW): The National Forum Web site is a prime resource for building public health capacity to prevent heart disease and stroke. The Web site is used by National Forum members and partners to disseminate current information, research, promote evidence-based practices and share training opportunities.

RECOMMENDATION

Identify, develop and disseminate model performance standards and core competencies in HDSP for national, state, and local public health agencies, including their laboratories.

Action Step: Facilitate development and dissemination of performance standards and core competencies for public health agencies and partners. Promote ongoing access to technical assistance, laboratory and clinical practice guidelines and performance standards for laboratory testing and standardization, and consultation to state and local health agencies, laboratories and partners for HDSP. Share performance standards and cultural competency guidelines with schools of public health and other educational sources for health professionals and encourage their adoption in curricula.

Expected Outcome: Performance standards and cultural competency guidelines for HDSP programs are established to help public health agencies transcend “business as usual” and undertake new directions in public health practice. Existing mandates are maintained, and efforts are expanded in early intervention (i.e., policy and environmental change; behavioral change; and prevention, detection, and control of risk factors). Laboratory capacity to address emerging issues is enhanced. Public health agencies are communicating with schools of public health and other training programs regarding training and curriculum requirements for public health personnel working in HDSP and related program areas.

Action Step: Identify mechanisms (e.g., technical assistance, dedicated funding and staff) that enable local and state health departments to meet standards.

Expected Outcome: Public health agencies are receiving technical assistance in monitoring and improving cultural competency in HDSP and related program areas.

Action Step (NEW): Promote and disseminate the competencies assessment tool developed by the National Association of Chronic Disease Directors to state-based heart disease and stroke prevention programs for use in assessing current competencies among their chronic disease/heart disease and stroke prevention staff, and identifying training needs in that area.

Expected Outcome (NEW): The competency assessment tool is recommended by the National Forum and available through the National Forum Web site. Use of the tool is promoted not only to state programs, but also to National Forum members and partners. Links are provided to training resources addressing the competencies.

Action Step (NEW): Promote existing guidelines and resources related to the enhancement of chronic disease epidemiology capacity to support the planning and evaluation of state and local heart disease and stroke prevention activities.

Expected Outcome (NEW): Existing resources related to chronic disease epidemiology capacity are promoted in support of planning and evaluation of state and local HDSP activities.

RECOMMENDATION

Provide ongoing access to technical assistance and consultation to state and local health agencies and partners for CVD prevention.

Action Step: Develop and maintain a cadre of educated practitioners and technical experts who can support intervention needs in heart disease and stroke prevention (e.g., surveillance and trend analysis; community development and behavior change; health care systems change and quality improvement; emergency response; disease management; program management and evaluation). Draw these practitioners and experts from local, state, and national public health agencies, as well as from voluntary health associations, academia, foundations, and a variety of industries. Assure the means for keeping their skills up-to-date (e.g., through meetings and Web-based curricula).

Expected Outcome: A register of recognized experts willing to provide technical and policy assistance to local, state and federal health agencies and other HDSP partners is established and maintained. Use of the registry is supported and monitored. Training and educational opportunities are provided, and the registered experts use them.

Action Step: Develop materials and tools to promote HDSP at local and state levels.

Expected Outcome: State and local health agency needs for HDSP promotional materials and an educational toolbox are being met.

Action Step: Strengthen the internal communications infrastructure of public health agencies for chronic disease programs as they make other general infrastructure improvements.

Expected Outcome: A public health communications infrastructure supportive of heart disease and stroke prevention (and other chronic disease) activities are in place and are continually adopting newer, more effective communications technology.

RECOMMENDATION (NEW)

Public health agencies, through their HDSP units, should be accountable for fulfilling their assurance function regarding quality of care in heart disease and stroke prevention and should be supported in this role through periodic conference calls, training opportunities, conferences, and other appropriate means.

Action Step (NEW): Work in collaboration with partners such as the state QIO’s, laboratory organizations and CHCC’s to monitor changing medical technology and care practices to assist in defining the public health role in improving systems of care.

Expected Outcome (NEW): Changing medical technology and care practices are being monitored to assist in defining public health’s role in systems change for HDSP.

Action Step (NEW): Provision of training and technical assistance for states on pay for performance, access to care, and quality of care issues.

Expected Outcome (NEW): State HDSP programs are receiving training and technical assistance on topics such as pay for performance, access to care, and quality of care.

Action Step (NEW): Foster effective systems for health care delivery (e.g., utilizing the chronic care model with emphasis on patient self-management and community resources).

Expected Outcome (NEW): Systems improvement is being fostered through state program efforts such as implementation of the chronic care model in outpatient clinical settings.

RECOMMENDATION (NEW)

Public health agencies should call for, and to the fullest extent possible conduct, both research and program evaluation relevant to public health practice and should maintain currency of knowledge in order to apply and disseminate it effectively.

Action Step (NEW): Develop and maintain sufficient capacity in chronic disease epidemiology and in program evaluation to assure timely awareness, application, and dissemination of knowledge relevant to HDSP programs.

Expected Outcome (NEW): State HDSP program capacity in chronic disease epidemiology and evaluation is being developed and maintained.

2008–2009 PRIORITIES

RECOMMENDATION

Facilitate and promote training resources to develop and maintain appropriately trained public health workforces at national, state, and local levels. These workforces should have all necessary competencies to bring about policy, environmental, and systems changes and implement programs to improve CVH and decrease the heart disease and stroke burden, including laboratory requirements.

Action Step: Utilize the National Forum’s Web site and links to other appropriate Web sites to establish a clearinghouse for training opportunities and other resources related to the assessment and improvement of program capacity and competencies, and voluntary accreditation related to heart disease and stroke prevention. This will include the identification and sharing of best practices and state success stories.

Expected Outcome: The National Forum Web site is a prime resource for building public health capacity to prevent heart disease and stroke. The Web site is used by National Forum members and partners to disseminate current information, research, promote evidence-based practices and share training opportunities.

RECOMMENDATION

Identify, develop and disseminate model performance standards and core competencies in HDSP for national, state, and local public health agencies, including their laboratories.

Action Step: Facilitate development and dissemination of performance standards and core competencies for public health agencies and partners. Promote ongoing access to technical assistance, laboratory and clinical practice guidelines and performance standards for laboratory testing and standardization, and consultation to state and local health agencies, laboratories and partners for HDSP. Share performance standards and cultural competency guidelines with schools of public health and other educational sources for health professionals and encourage their adoption in curricula.

Expected Outcome: Performance standards and cultural competency guidelines for HDSP programs are established to help public health agencies transcend “business as usual” and undertake new directions in public health practice. Existing mandates are maintained, and efforts are expanded in early intervention (i.e., policy and environmental change; behavioral change; and prevention, detection, and control of risk factors). Laboratory capacity to address emerging issues is enhanced. Public health agencies are communicating with schools of public health and other training programs regarding training and curriculum requirements for public health personnel working in HDSP and related program areas.

5. Monitoring and Evaluation Implementation Group

Chair: David C. Goff, Jr. (Team A Chair)
Vice Chair: Wayne Rosamond (Team B Chair)
Team A Members: Christine Albert; Lynne Braun; Janet Croft; Judd Flesch; Frances G.R. Fowkes; Yuling Hong; Virginia Howard; Sara Huston; Russell Leupker; Teri Manolio; John Marler;
Karen Modesitt; Christopher O’Donnell; Rose Marie Robertson; John Rumsfeld; Stephen Sidney; Sylvie Stachenko; Mark Veazie; Zhi Jie Zheng
Team B Members: Alice Ammerman; Semra Aytur; Kelly Evenson; Jan Jernigan; Laura Linnan; Albert Tsai; Abha Varma

MISSION

To monitor the burden of heart disease and stroke and measure progress in the prevention and treatment of heart disease and stroke by —

• Expanding and standardizing population data sources and activities.
• Establishing frameworks, methods, and core indicators for evaluation of policy, environmental, and systems change interventions.
• Developing professional staff capacity for monitoring and evaluation.

The following contains the Monitoring and Evaluation Implementation Group’s suggested updates to recommendations in A Public Health Action Plan to Prevent Heart Disease and Stroke (Action Plan). These suggestions are based on the current environment for heart disease and stroke prevention activities around the world. New recommendations, action steps, and expected outcomes are indicated by “(NEW).” Please refer to the Action Plan for the original Recommendations, Action Steps, and Expected Outcomes.

The Monitoring and Evaluation Implementation Group’s priority Recommendation, Action Steps, and Expected Outcomes to be undertaken on behalf of the National Forum in 2008–2009 are given at the end of the Group’s list of updates.

RECOMMENDATION

Expand and standardize population-wide surveillance data sources and activities to assure adequate assessment of CVD indicators and change in the nation’s CVD burden. Examples include mortality, incidence, prevalence, disability, selected biomarkers, risk factors and risk behaviors, economic burden, community and environmental characteristics, current policies and programs, and socio-demographic factors (e.g., age, race/ethnicity, sex, and zip code).

Action Step: Define the characteristics of surveillance systems at minimal, desirable, and optimal levels. Establish an inclusive framework and set of indicators on the basis of 1) a review of existing surveillance and evaluation frameworks (e.g., the World Health Organization’s STEPwise approach, Canada’s recent development of surveillance priorities); 2) the new requirements for monitoring policy and environmental change; behavioral change; biomarkers of CVD risk; and risk factor prevention, detection, and control; and 3) input from national, state, and local stakeholders and partner organizations. Include social and environmental science and policy experts and those who collect, analyze, or use relevant data.

Expected Outcome: A framework is reviewed and established for assessing data requirements for monitoring and evaluating the comprehensive public health strategy. It includes a mechanism for periodic updates and reassessments.

Action Step: Assess the adequacy of current systems on the basis of these characteristics and the need for dynamic, interactive data access and use. Include the experts and stakeholders described in the previous action step.

Expected Outcome: An initial inventory of health indicators (including applicable leading health indicators from Healthy People 2010) and relevant surveillance and evaluation data sources is completed and disseminated to appropriate agencies and organizations for review and comment.

Action Step: Convene public health agencies and partners to determine the mechanisms and costs needed to fill identified information gaps. Improve existing data sets and develop new ones as needed, with attention to timeliness, sustainability, and standardization. Address standardization of data systems across states, approaches to active or passive data collection, ongoing versus episodic data collection requirements, availability of data from health care insurers, and the paramount importance of incidence data for monitoring progress in preventing heart disease and stroke. Devise common data formats, data management policies and practices, and methods for controlling interconnected data systems.

Expected Outcome: A group has convened and formulated a detailed implementation plan for developing the monitoring data systems needed to support the Action Plan.

Action Step: Use data to plan health programs and to communicate consistent messages about the urgency of preventing heart disease and stroke. Enhance the incorporation of current CVH data into broader social indicator reports, using model programs and tested tools, formats, and templates for communicating and disseminating this information.

Expected Outcome: As the available data are used to communicate CVH messages, their strengths and limitations and the current systems for managing and coordinating these data are continuously monitored. System development is advanced and adapted to changing needs.

RECOMMENDATION

Establish frameworks, methods and core indicators for evaluation of policy, environmental and systems change interventions. Embrace the importance of appropriate evaluation practices to guide future intervention development. Investigate evaluation processes and practices that are innovative or promising to improve the scientific basis for recommendations pertaining to policies and programs for heart disease and stroke prevention.

Action Step: Assure that resources are allocated when projects or model programs are first funded by public health agencies and partners (e.g., personnel or financial set-asides) to permit adequate evaluation of outcomes and costs.

Expected Outcome: Evaluation is an expected component of every public health program aimed at preventing heart disease and stroke. No program proceeds without commitment to support this component.

Action Step: Develop guidelines for public health agencies and partners for content and format of such evaluations, especially in the new areas of policy and environmental change; behavioral change; and risk factor prevention, detection, and control.

Expected Outcome: Tools are widely available to support evaluations and the timely communication of their findings. This allows the most effective interventions to be replicated quickly. Mechanisms for disseminating and reviewing evaluation results are strengthened to assure that the knowledge and experience gained are applied in future policies and programs.

Action Step (NEW): Enhance the state HDSP Program Management Information System with standard program goals reflecting the priority areas, objectives (short-term, intermediate, and long-term) falling under each goal, and standard process and outcome indicators to better measure and illustrate progress toward program objectives and goals.

Expected Outcome (NEW): Each state HDSP Program has in place an information system that matches its program goals within priority areas in environment and policy interventions with recommended guidelines for content and format for evaluation. The information system in place allows for the tracking of progress of policy and environmental interventions along the lines of the recommended parameters and format.

Action Step (NEW): Develop key outcome indicators for evaluating comprehensive heart disease and stroke programs.

Expected Outcome (NEW): Indicators useful in evaluating the impact on policy and environment change are widely disseminated, understood and used by the wide variety of groups involved in designing and implementing (and funding) systems level interventions. The key outcome indicators connect with the guidelines established for content and format of systems level evaluation.

RECOMMENDATION

Enhance the public health infrastructure, build personnel competencies, and facilitate the development and effective use of communication mechanisms so that federal, state, and local public health agencies can disseminate and use surveillance and evaluation results in a timely and effective manner.

Action Step: Strengthen the surveillance and program evaluation functions of public health agencies through enhanced staffing and resources, especially for monitoring policy and environmental change; behavioral change; and risk factor prevention, detection, and control.

Expected Outcome: Professional staff development for monitoring and evaluation, especially in the new areas required by the plan, is a priority for all public health agencies, which have expanded their capacity for advancing methods and practices in heart disease and stroke prevention surveillance and program evaluation.

Action Step: Provide guidance to state and local health agencies and partners regarding capacity requirements for surveillance and evaluation activities.

Expected Outcome: State and local public health agencies are receiving help in determining what capacities they need to conduct surveillance/monitoring and to evaluate their programs.

Action Step: Establish resources to support program evaluation and surveillance through training, consultation, technical assistance, and partnerships to develop logic models, methodology, data collection, and reporting.

Expected Outcome: A plan for meeting these requirements is developed and implemented.

2008–2009 PRIORITY

RECOMMENDATION

Enhance the public health infrastructure, build personnel competencies, and facilitate the development and effective use of communication mechanisms so that federal, state, and local public health agencies can disseminate and use surveillance and evaluation results in a timely and effective manner.

Action Step: Provide guidance to state and local health agencies and partners regarding capacity requirements for surveillance and evaluation activities.

Expected Outcome: State and local public health agencies are receiving help in determining what capacities they need to conduct surveillance/monitoring and to evaluate their programs.

Action Step: Establish resources to support program evaluation and surveillance through training, consultation, technical assistance, and partnerships to develop logic models, methodology, data collection, and reporting.

Expected Outcome: A plan for meeting these requirements is developed and implemented.

6. Policy Research Implementation Group

Chair: Gregory Burke
Vice Chair: George Howard
Members: Rosanne Farris; Erick Finkelstein; Thomas T. Fogg; Meredith Kilgore, Max Michael; Javier Nieto; Diane Orenstein; Matt Schnellbaecher; Nancy Watkins, Alexander White,
Armineh Zohrabian

MISSION

To develop a comprehensive policy research agenda, foster translating this research into practice, and investigate relevant economic models.

The following contains the Policy Research Implementation Group’s suggested updates to recommendations in A Public Health Action Plan to Prevent Heart Disease and Stroke (Action Plan). These suggestions are based on the current environment for heart disease and stroke prevention activities around the world. New recommendations, action steps, and expected outcomes are indicated by “(NEW).” Please refer to the Action Plan for the original Recommendations, Action Steps, and Expected Outcomes.

The Policy Research Implementation Group’s priority Recommendation, Action Step, and Expected Outcome to be undertaken on behalf of the National Forum in 2008–2009 are given at the end of the Group’s list of updates.

RECOMMENDATION

Conduct and facilitate research with partners to identify new policy, environmental, social, and economic priorities for CVH promotion; determine the appropriate methods for translation and dissemination of knowledge; and, fund research to identify best practices for effective interventions to translate science into practice.

Action Step: Focus on preventing CVD risk factors. Develop and support a collaborative, detailed, and interdisciplinary research agenda and a new framework for policy, environmental, and behavioral research to determine which interventions (separately or in combination) will best affect CVD risk factors and their contribution to the burden of heart disease and stroke. Support both targeted and investigator-initiated research.

Expected Outcome: A research agenda specific to the major focus of preventing CVD risk factors is developed and implemented.

Action Step: Support research to determine the best ways to implement and disseminate the most effective policy, environmental, systems, or behavioral change interventions to prevent heart disease and stroke. Identify social and cultural factors that promote or inhibit the sustainability of interventions, especially among populations affected by disparities in CVD risk (based on race/ethnicity, income, or place of residence).

Expected Outcome: A detailed research agenda is developed and supported, in alignment with the Research Themes and Research Priority Areas of the U.S. Department of Health and Human Services, with special emphasis on policy and environmental change related to CVH promotion and CVD prevention.

Action Step: Conduct research to answer questions such as the following: What are the social and structural factors in various settings and sectors that affect CVH status more than individual characteristics? What are specific antecedent factors associated with specific components of risk (e.g., food intake, physical activity, adherence to preventive medical care)? What are the social and cultural determinants of food consumption and physical activity among children and families? How do these factors differ by characteristics such as age, income, or race? What is the public health importance of currently available genetic and other biomarkers of risk or disease?

Expected Outcome: A broad array of relevant research questions is developed and prioritized to balance the research agenda.

Action Step: Develop and support a collaborative research agenda that focuses on health outcomes. Establish effective interventions to overcome barriers and improve access to and use of high-quality medical services for patients with or at risk for heart disease and stroke.

Expected Outcome: The research agenda includes studies to identify potential points of intervention to improve preventive services and access to and use of these services. This agenda supports the four goals for preventing heart disease and stroke as distinguished by the Healthy People 2010 Heart and Stroke Partnership. These goals are prevention of risk factors, detection and treatment of risk factors, early detection and treatment of heart attacks and strokes, and prevention of recurrent cardiovascular events.

Action Step: Support prevention effectiveness research to determine what combinations of effective interventions (e.g., policy, environment, individual) at what doses, in what settings (e.g., family, school, work site, health care, community), at what life stages, and among which priority populations are most effective in preventing, detecting, and controlling CVD risk factors.

Expected Outcome: The research agenda includes studies involving the proposed matrix of settings, life stages, and priority populations to determine the most effective interventions within and across populations (including populationwide approaches and those aimed specific subgroups).

Action Step: Express strong support for this new research agenda with the help of partners positioned to educate key stakeholders, to help policy makers recognize its value, and to assure its implementation and the continual advancement of resulting policies and programs.

Expected Outcome: The research agenda is supported by education to assure that funding is a national priority.

Action Step (NEW): Develop an expert workshop on economics of heart disease and stroke prevention in order to develop an economics and policy research agenda to inform public health and systems change in prevention, detection, and management of cardiovascular risk factors. Include experts in health economics, health policy research, heart disease and stroke, and public health.

Expected Outcome (NEW): The workshop has been convened, criteria for developing priorities have been developed and applied in prioritizing recommendations, and a dissemination strategy is in place regarding publication, advocacy, and funding.

RECOMMENDATION

Design, plan, implement and evaluate interventions in priority settings across the age-span and continuum of heart disease and stroke prevention risk factors and conditions.

Action Step: Develop and support detailed research agendas that specifically address prevention across the age span. Include studies that assess the impact of known interventions in preventing risk factors for heart disease and stroke.

Expected Outcome: A detailed research agenda is developed and supported to design, implement, and evaluate intervention programs to prevent CVD risk factors, especially addressing atherosclerosis and high blood pressure, beginning in childhood.

Action Step: Identify subclinical indicators of CVD and potentially useful genetic and other biomarkers that can be applied in population studies and prevention programs. Work with appropriate health service and industry partners.

Expected Outcome: The research agenda includes research to develop assessment methods to evaluate new candidate biomarkers in population studies across the age span.

Action Step: Identify other outstanding concerns in preventing risk factors.

Expected Outcome: The research agenda includes research on underlying determinants of CVD risk factors.

RECOMMENDATION

Conduct and facilitate research on improvements in surveillance methods and data collection and management methods for policy development, environmental change, performance monitoring, identification of key indicators, and capacity development. Address population subgroups in various settings (schools, work sites, health care, and communities) at local, state and national levels. Identify new technologies and regulations affecting surveillance systems including approaches to monitor environmental and policy characteristics at the local level.

Action Step: Support monitoring and evaluation research to determine how best to measure policy and environmental change interventions.

Expected Outcome: The research agenda includes studies of methods and data requirements for monitoring and evaluating approaches to policy and environmental change.

Action Step: Incorporate these measures into surveillance systems.

Expected Outcome: Surveillance methods that incorporate the relevant data elements are developed and implemented.

Action Step: Respond to technological developments and regulations that restrict access to personal health information to assure the appropriate levels of participation and representation in surveillance activities.

Expected Outcome: Methods that assure adequate participation rates and representative population samples are continuously investigated, addressing technical and policy concerns about access to health information.

RECOMMENDATION

Conduct and support research to determine the most effective marketing messages and educational campaigns to create demand for heart-healthy options, change behavior, and prevent heart disease and stroke for specific target groups and settings. Create and evaluate economically viable CVD prevention ventures (e.g., in food production, manufacturing, marketing).

Action Step: Support marketing research on how to inform the public effectively and bring about health behavioral change.

Expected Outcome: The research agenda includes studies of what influences the way people respond to population-wide and individual media and educational interventions to prevent heart disease and stroke in the community at large, in specific cultural communities, and in specific organizational settings.

Action Step: Support research to demonstrate the economic feasibility of and appropriate business models for private sector investment in prevention (e.g., in food production, manufacturing, or marketing).

Expected Outcome: The research agenda includes studies of how consumer products could be changed to support policies and programs to reduce risk for heart disease and stroke and still be viable commercially. This research includes partners in business and industry.

RECOMMENDATION

Initiate and strengthen training grants and other approaches, such as training workshops and supervised research opportunities, to build the competencies needed to implement the CVD prevention research agenda.

Action Step: Inventory current prevention research training programs and research opportunities in view of the expanding need for new health research skills.

Expected Outcome: Workforce requirements for establishing and maintaining broad-based CVD prevention research programs are documented. Training programs to meet current and future requirements are identified and evaluated.

Action Step: Emphasize policy and environmental change, health behavioral change, and risk factor prevention when seeking to identify training needs and develop responsive plans.

Expected Outcome: Gaps in training resources are identified, and detailed plans for filling them are developed. Resources are identified and committed to support the needed training in CVH prevention research.

2008–2009 PRIORITY

RECOMMENDATION

Conduct and facilitate research with partners to identify new policy, environmental, social, and economic priorities for CVH promotion; determine the appropriate methods for translation and dissemination of knowledge; and, fund research to identify best practices for effective interventions to translate science into practice.

Action Step: Develop an expert workshop on economics of heart disease and stroke prevention in order to develop an economics and policy research agenda to inform public health and systems change in prevention, detection, and management of cardiovascular risk factors. Include experts in health economics, health policy research, heart disease and stroke, and public health.

Expected Outcome: The workshop has been convened, criteria for developing priorities have been developed and applied in prioritizing recommendations, and a dissemination strategy is in place regarding publication, advocacy, and funding.

7. Regional and Global Collaboration Implementation Group

Chair: Thomas Pearson
Vice Chair: Beatriz Marcel Champagne
Members: Gladys Branic; Amy Carte; Arun Chockalingham; Catherine Coleman; Bruce Coull; Linnea Evans; Jill Farrington; Ivonne Fuller; James Galloway; James Hospedales; Marsha Houston; Randy Kirkendall; David MacLean; David McQueen; Belinda Minta; Sania Nishtar; Gilles Paradis; Philip Poole-Wilson; Iraj Poureslami; Jim Toole

MISSION

To engage regional and global partners to mobilize resources in heart disease and stroke prevention and treatment.

The following contains the Regional and Global Collaboration Implementation Group’s suggested updates to recommendations in A Public Health Action Plan to Prevent Heart Disease and Stroke (Action Plan). These suggestions are based on the current environment for heart disease and stroke prevention activities around the world. New recommendations, action steps, and expected outcomes are indicated by “(NEW).” Please refer to the Action Plan for the original Recommendations, Action Steps, and Expected Outcomes.

The Regional and Global Collaboration Implementation Group’s priority Recommendations, Action Steps, and Expected Outcomes to be undertaken on behalf of the National Forum in 2008–2009 are given at the end of the Group’s list of updates.

RECOMMENDATION

Engage with regional and global partners to mobilize resources in CVH promotion and CVD prevention an d establish or strengthen liaison with partners identified in these recommendations.

Action Step: Inventory existing and potential partners for global CVD collaboration, with support from public health agencies and other partners. Include governmental agencies, nongovernmental organizations, and foundations (e.g., especially the World Health Organization, World Heart Federation, and World Bank).

Expected Outcome: Inventories of existing regional and global CVH partnerships, potential nontraditional CVH partnerships, and foundations that support international activities for medical and public health training are established and maintained.

Action Step: Assess the potential for collaboration and cooperation in current CVH research and training programs of these potential partners. Evaluate their interest in receiving information and technical support from public health agencies to enhance these programs and in planning joint projects or programs.

Expected Outcome: An inventory of current agendas for integrated CVH programs, linked with other chronic conditions of public health importance, is established and maintained. Joint projects with regional and global partners are planned and implemented.

Action Step (NEW): Include entities with policy roles that might conflict with CVH priorities, but who could become effective partners (e.g., the food and agriculture sector).

Expected Outcome (NEW): An inclusive partnership on global CVH strategy is established.

RECOMMENDATION

Develop and implement global CVH policies with regional and global partners.

Action Step: Develop and effectively support a global mission and vision of the United States for CVH.

Expected Outcome: A statement of the U.S. position, role, and interest regarding global CVH needs and opportunities has been published and serves as a point of reference for partnership development in this area.

Action Step: Work with national and global partners to assess the impact of globalization and trade policies on national and international trends in CVD and suggest policy modifications that could favorably affect CVH.

Expected Outcome: Study results are published on the impact of globalization and trade policies (especially those related to tobacco, food, and pharmaceuticals) on CVH, as well as the opportunities to use these policies to promote CVH nationally and globally.

Action Step (NEW): Develop and effectively support evidence-based CVH policies globally, and assess and monitor global policy strategies.

Expected Outcome (NEW): A partnership on global CVH strategy and evidence-based CVH policies is established. Its implementation plan is guided by a commitment to work toward eliminating inequalities in CVH.

RECOMMENDATION

Address inequalities in CVH among developed and developing countries, rich and poor people within countries, and men and women of all ages. Work with national and global partners to assess the impact of globalization and trade policies on global CVH.

Action Step: Identify priorities to assess progress in eliminating inequalities in CVH in the United States and globally, and assess the contribution of this country’s global strategy in reducing CVH inequalities worldwide.

Expected Outcome: A framework to assess progress on equity in national and global CVH programs is being used.

RECOMMENDATION

Develop diverse communication channels to promote and support CVH globally.

Action Step: Draw on relationships between appropriate communication channels and public health agencies and partners to share knowledge and identify models of collaboration that can help improve media content and coverage on the need for global CVH promotion and CVD prevention.

Expected Outcome: Consensus development meetings are conducted among CVH partners and communication representatives. Better CVH messages are communicated.

Action Step: Effectively communicate to health professionals and policy makers throughout the world that they should promote best practices for CVH by supporting effective policies and by serving as role models for positive behavioral patterns.

Expected Outcome: Programs are undertaken by local partners to reach health professionals throughout the world with effective messages about their role in preventing heart disease and stroke.

Action Step (NEW): Promote the use of innovative communication technologies (e.g., youtube.com, allafrica.com).

Expected Outcome (NEW): Innovative communication technologies are being used and examples are disseminated and evaluated for their reach and impact.

Action Step (NEW): Promote cardiovascular health literacy.

Expected Outcome (NEW): Evidence regarding cardiovascular health literacy in targeted audiences or populations indicates improvements responsive to promotional activities.

RECOMMENDATION

Strengthen global capacity to develop, implement, and evaluate policy and program interventions to prevent and control heart disease and stroke. Involve all relevant parties—governmental and nongovernmental, public and private, and traditional and nontraditional partners—in a systematic and strategic approach.

Action Step: Develop tailored programs to disseminate evidence-based and promising programs and models that 1) assist and support decision makers interested in developing and implementing effective national policies, 2) develop methodology and tools to analyze the health impact of policy interventions, and 3) analyze the social and economic costs of heart disease and stroke and the benefits of preventing them.

Expected Outcome: Development of capacity for heart disease and stroke prevention is recognized as a long-term requirement for transforming public health agencies. Culturally sensitive and resource specific (NEW) training programs and workshops are available and being used. International conferences are conducted on the economics of heart disease and stroke prevention and the links between economic conditions and CVH.

Action Step: Promote the exchange of information and experiences in policies that promote CVH.

Expected Outcome: Information and experience related to CVH promotion are effectively disseminated and applied.

Action Step: Make methods and tools available and assist partners in their adaptation to analyze policy and environmental change.

Expected Outcome: Tools for analyzing how policies affect the global dimensions of CVH are developed and disseminated.

Action Step: Develop and implement strategies and resources to assure that changes that support the Action Plan are institutionalized.

Expected Outcome: Capacity is developed in a way that assures institutionalization of change.

RECOMMENDATION

Strengthen global focus and increase partnerships intended to develop and implement standards for adequate monitoring of health, social and economic indicators on a regional and global level.

Action Step: Inventory existing surveys, programs, and agreements relevant to global monitoring and evaluation activities in heart disease and stroke prevention and control.

Expected Outcome: A Web-based inventory is available and routinely updated.

Action Step: Identify existing monitor programs that could be expanded and areas where new collaborations could be created.

Expected Outcome: New regional and global collaborative activities are established, and new opportunities are being identified.

Action Step: Support monitoring of heart disease and stroke globally by working with existing and new partners (especially WHO) to develop standard data elements. Assure effective dissemination of the resulting information and its translation into action.

Expected Outcome: Guidelines for standard data collection and methods for planning and evaluating heart disease and stroke prevention and control programs are developed and being used. Training programs for technical assistance/collaboration on CVD projects are receiving needed financial support.

RECOMMENDATION

Promote and support research on implementing and evaluating CVH policy and program interventions in diverse settings where different social and economic development and health transition experiences offer contrasting conditions for testing new policy and program intervention approaches.

Action Step: Collaborate in developing a research agenda on CVH policy and program interventions. Identify appropriate international partners to design research and mobilize resources.

Expected Outcome: Public health agencies are actively designing and conducting policy and research programs to identify best practices for preventing heart disease and stroke in diverse socioeconomic settings, both nationally and globally.

2008–2009 PRIORITIES

RECOMMENDATION

Engage with regional and global partners to mobilize resources in CVH promotion and CVD prevention and establish or strengthen liaison with partners identified in these recommendations.

Action Step: Inventory existing and potential partners for global CVH collaboration, with support from public health agencies and other partners. Include governmental agencies, nongovernmental organizations, and foundations (e.g., especially the World Health Organization, World Heart Federation, and World Bank).

Expected Outcome: Inventories of existing regional and global CVH partnerships, potential nontraditional CVH partnerships, and foundations that support international activities for medical and public health training are established and maintained.

RECOMMENDATION

Strengthen global capacity to develop, implement, and evaluate policy and program interventions to prevent and control heart disease and stroke. Involve all relevant parties—governmental and nongovernmental, public and private, and traditional and nontraditional partners—in a systematic and strategic approach.

Action Step: Develop tailored programs to disseminate evidence-based and promising programs and models that 1) assist and support decision makers interested in developing and implementing effective national policies, 2) develop methodology and tools to analyze the health impact of policy interventions, and 3) analyze the social and economic costs of heart disease and stroke and the benefits of preventing them.

Expected Outcome: Development of capacity for heart disease and stroke prevention is recognized as a long-term requirement for transforming public health agencies. Culturally sensitive and resource specific training programs and workshops are available and being used. International conferences are conducted on the economics of heart disease and stroke prevention and the links between economic conditions and CVH.

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Page last reviewed: August 12, 2008
Page last modified: August 12, 2008
Content source: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion