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2008 Public Health Action Plan Update: Celebrating Our First Five YearsA 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 GroupsThis 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 GroupChair: Michael Greenwell 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.
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.
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.
Action Step (NEW): Develop communication strategies to effectively communicate with those populations most at risk and address inequities in access to health care.
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.
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.
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.
2008–2009 PriorityRECOMMENDATION 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.
2. Public Health Leadership Implementation GroupChair: James Baranksi 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).
Action Step: Convene agencies at all levels to help develop implementation plans at state and local levels.
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.
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.
Action Step (NEW): Establish and improve partnerships to develop, implement, and evaluate plans to address heart disease and stroke.
Action Step (NEW): Educate key decision makers to support heart disease and stroke prevention policies and programs.
2008–2009 PRIORITYRECOMMENDATION 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.
Action Step: Educate key decision makers to support heart disease and stroke prevention policies and programs.
3. Action Priorities Implementation GroupChair: William Caplan 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).
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.
Action Step: Advocate for health impact assessments of national policies and provide a framework to states to conduct these assessments at the state level.
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).
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.
Action Step: Identify and disseminate information about model programs that include all elements of best practices for a population–based approach to CVH.
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.
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).
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.
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.
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.
2008–2009 PRIORITYRECOMMENDATION 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).
4. Organizational Capacity Implementation GroupChair: Joan Ware 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.
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.
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.
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.
Action Step: Assure training in the following set of skills, which are essential to an effective public health workforce:
Action Step: Consider a variety of options for training personnel.
Possibilities include the following:
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:
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.
Action Step: Identify mechanisms (e.g., technical assistance, dedicated funding and staff) that enable local and state health departments to meet standards.
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.
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.
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).
Action Step: Develop materials and tools to promote HDSP at local and state levels.
Action Step: Strengthen the internal communications infrastructure of public health agencies for chronic disease programs as they make other general infrastructure improvements.
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.
Action Step (NEW): Provision of training and technical assistance for states on pay for performance, access to care, and quality of care issues.
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).
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.
2008–2009 PRIORITIESRECOMMENDATION 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.
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.
5. Monitoring and Evaluation Implementation GroupChair: David C. Goff, Jr. (Team A Chair) MISSION To monitor the burden of heart disease and stroke and measure progress in the prevention and treatment of heart disease and stroke by —
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.
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.
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.
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.
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.
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.
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.
Action Step (NEW): Develop key outcome indicators for evaluating comprehensive heart disease and stroke programs.
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.
Action Step: Provide guidance to state and local health agencies and partners regarding capacity requirements for surveillance and evaluation activities.
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.
2008–2009 PRIORITYRECOMMENDATION 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.
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.
6. Policy Research Implementation GroupChair: Gregory Burke 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.
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).
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?
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.
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.
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.
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.
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.
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.
Action Step: Identify other outstanding concerns in preventing 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.
Action Step: Incorporate these measures into surveillance systems.
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.
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.
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).
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.
Action Step: Emphasize policy and environmental change, health behavioral change, and risk factor prevention when seeking to identify training needs and develop responsive plans.
2008–2009 PRIORITYRECOMMENDATION 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.
7. Regional and Global Collaboration Implementation GroupChair: Thomas Pearson 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).
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.
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).
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.
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.
Action Step (NEW): Develop and effectively support evidence-based CVH policies globally, and assess and monitor global policy strategies.
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.
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.
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.
Action Step (NEW): Promote the use of innovative communication technologies (e.g., youtube.com, allafrica.com).
Action Step (NEW): Promote cardiovascular health literacy.
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.
Action Step: Promote the exchange of information and experiences in policies that promote CVH.
Action Step: Make methods and tools available and assist partners in their adaptation to analyze policy and environmental change.
Action Step: Develop and implement strategies and resources to assure that changes that support the Action Plan are institutionalized.
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.
Action Step: Identify existing monitor programs that could be expanded and areas where new collaborations could be created.
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.
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.
2008–2009 PRIORITIESRECOMMENDATION 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).
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.
Page last reviewed:
August 12, 2008 |
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