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

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Reflections From the Chair of the National Forum

Darwin R. Labarthe, MD, PhD, MPH
Chair, National Forum for Heart Disease and Stroke Prevention

This foreword is a personal perspective on the developments culminating at this 5-year mark in implementing A Public Health Action Plan to Prevent Heart Disease and Stroke. Perhaps it suggests a measure of naiveté, since I arrived late in my career to the mainstream of public health practice and have been swept along by the force of a powerful current. As a result, I am now an academic turned public health practitioner.

An accidental consequence of writing a book led me to the Centers for Disease Control and Prevention (CDC). In 1998, I was on the faculty at the University of Texas School of Public Health in Houston. I had just finished writing a textbook on epidemiology and the prevention of cardiovascular diseases as a global challenge. The bulk of my work was on the science of cardiovascular epidemiology and prevention. I was conscious that in the 30 years I had been at the university, my work in public health was somewhat lean.

About this same time, the U.S. Congress appropriated the first funds for CDC to support state health departments in cardiovascular health. By the beginning of 1999 a state cardiovascular health program was starting, and CDC leaders determined that a long-range strategic plan for state cardiovascular health programs was in order through the National Center for Chronic Disease Prevention and Health Promotion. All of this was happening just as I was realizing the extent of unmet needs in public health approaches to cardiovascular disease prevention . I thought, this could possibly be the most exciting position in the world from which to work on heart disease and stroke prevention — the opportunity to participate in CDC’s development of activities in this area. In January 2000, I joined CDC to lead the development of a strategic plan to promote achievement of the Healthy People 2010 national goals for preventing heart disease and stroke during the next two decades and beyond.

The question then was how to go about developing this strategic plan. States had a high level of interest in what such a plan would look like. They made it clear that, if the plan were to be of any practical value, representatives of the state public health agencies must be significantly engaged in its development. Therefore, to ensure the states’ input into the process that was to lead to A Public Health Action Plan to Prevent Heart Disease and Stroke, we collaborated with the Cardiovascular Health Council, which is part of National Association of Chronic Disease Directors, which in turn is part of the Association of State and Territorial Health Officials.

By mid-2001, two parallel tracks converged: one within and one outside CDC. CDC committed significant resources to the process of developing the strategic plan and recruited outside experts in heart disease and stroke prevention to collaborate with CDC staff in structuring the plan. Nominations for participants were solicited from the Cardiovascular Health Council and from the CVH Coordinating Committee of the National Center for Chronic Disease Prevention and Health Promotion. I invited acquaintances from academic and government agencies working on epidemiology and prevention to participate in leading the process. From the beginning, the American Heart Association/American Stroke Association and the Association of State and Territorial Health Officials were co-lead partners with CDC in the development of the plan.

On December 6, 2001, a working group consisting of five expert panels met to provide guidance to the process. The five expert panels were each given a separate mission to cover different components of the proposed plan

1. taking action,
2. strengthening capacity,
3. evaluating impact,
4. advancing policy, and
5. regional and global partnerships.

A series of meetings from January through May 2002 yielded draft recommendations, proposed action steps, and expected outcomes. Also recommended was the inclusion of two other major components to the plan: effective communication and and strategic leadership.

In September 2002, the working group convened a meeting in Washington, D.C., to obtain broader input for the “national action plan for cardiovascular health.” With input from this convened group of national and international experts in heart disease and stroke prevention, a draft document of the “national action plan for cardiovascular health” was submitted to the U.S. Department of Health and Human Services for clearance to publish. Interestingly, this occurred on December 6, 2002, one year to the day from the first working group meeting. There was no expectation that the September 2002 meeting would be anything more than a one-time event. This was still the case when the Action Plan was released by U.S. Department of Health and Human Services Secretary Tommy Thompson at the first Steps to a HealthierUS summit in April, 2003.

During the working group meeting at the Steps to a HealthierUS summit, it was recommended that the National Forum be constituted on a permanent basis as the primary multipartner vehicle for implementing the Action Plan. It is now tradition that a spring meeting of the National Forum to Prevent Heart Disease and Stroke is held annually in Washington, D.C. This gathering now includes a fairly constant composition of 80 to 85 national and international organizations and individual members.

Looking back over the first five years of activities to implement the Action Plan, we can all be proud of the significant accomplishments achieved through the collective efforts of many partners and colleagues. I am personally proud that we have institutionalized the National Forum by coming together to create a vision and mission that goes above and beyond our individual interests and that we have achieved results no single organization could achieve alone

• Created a strategic action plan to carry us to 2020 and beyond.
• Developed key messages for marketing National Forum materials and products.
• Co-authored the article “Essential Features of a Surveillance System to Support the Prevention and Management of Heart Disease and Stroke,” which was published in the January 2, 2007, issue of Circulation. This seminal report fulfills the Action Plan’s call for critical assessment of U.S. data sources to support heart disease and stroke prevention and recommends 11 measures for building a system adequate to today’s requirements.
• Developed resources to make the case for investing in prevention such as the National Forum Reader on Economics and Prevention, which contains articles, commentaries, and key references on the economics of health promotion and disease prevention.
• Developed a tool to rate policy issues on the basis of their potential effects on public health. The National Forum will use the ratings of this tool to guide its efforts in prioritizing policy, environmental, and system change initiatives within a comprehensive cardiovascular health policy plan.
• Published an update to the Action Plan — a review and reaffirmation of the Action Plan recommendations by the seven Implementation Groups of the National Forum.

On the basis of these and other accomplishments, we now have an even greater opportunity than in 2003 to mobilize action to prevent heart disease and stroke and a greater accountability for doing so. These are some items that remain to be done

• Establish a leadership council of prominent experts along the lines of a presidential commission or national blue-ribbon panel to help increase the visibility of the National Forum and assist in resource development so that the Forum will be better able to achieve its goals.
• Craft prevention messages in clear terms that lead to meaningful action. Society has a strong interest in the first of the Action Plan’s strategic imperatives: to strike a new balance in our investment in health by putting prevention first. We need to communicate effectively, and in the right places, the tremendous potential for prevention.
• Continue progress in transforming public health agencies into their new role as leaders for chronic disease prevention, which includes creating and sustaining multi-sector partnerships to bring about policy, environmental, and system changes that will improve cardiovascular health.
• Increase our focus on the critical role of upstream approaches to intervention (i.e., preventing the risk factors for heart disease and stroke). We must not wait to treat risk factors and their consequences until after they occur when we know it is possible to prevent people acquiring these risk factors in the first place.

The National Forum is at a stage where growth in the number of committed member organizations and agencies is essential to increasing our capacity and impact and to maintaining diversity across all sectors of society. Converging forces brought us to a significant point in tackling the challenges of heart disease and stroke prevention. The Action Plan and the National Forum have attracted the interest and commitment of organizations and individuals with a common purpose and is a model for chronic disease prevention and health promotion.

People elsewhere look to the United States for leadership in public health. To the extent that we have yet to become fully engaged in preventing preventable chronic disease, we reflect complacency about our current health situation. We also have a substantial effect on the health of other countries through our own policies on agriculture, trade, and financial aid. I hope the National Forum can be a meaningful force for a more enlightened policy both within the United States and throughout the world.

My coming to CDC was, in part, an unintended consequence of writing a book. I am now in the latter stages of a second edition to that book. The first edition was an epidemiologist’s book; the second edition, I think, will be a public health practitioner’s book. The content has changed during these recent years in part because of the significant developments I have described here.

As I complete my tenure as Chair of the National Forum, know that I will continue to join you in embracing the immense opportunities that lie ahead for the National Forum. It has been my pleasure to serve as the first Chair of the National Forum for Heart Disease and Stroke Prevention, and in closing, I echo the message of the Victoria Declaration on Heart Health, a mantra of the Action Plan: “We know what to do; we need to do what we know.”

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Page last reviewed: August 18, 2008
Page last modified: August 18, 2008
Content source: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion