(Circulation. 2001;103:2870.)
© 2001 American Heart Association, Inc.
Editorial |
Partnerships for the Health of the Public
From Vanderbilt University Medical Center, Nashville, Tenn.
Correspondence to Rose Marie Robertson, MD, Vanderbilt University Medical Center, 2220 Pierce Ave, MRB II, Room 315, Nashville, TN 37232-6300. E-mail rosemarie.robertson{at}mcmail.vanderbilt.edu
Key Words: Editorials • coronary disease • resuscitation • stroke • prevention
In the year 2000, the American Heart Association focused its human and financial resources on an ambitious goal with important implications for the health of the American public. We committed to reduce the impact of coronary heart disease and stroke and the risk of these disorders by 25% by 2010. To begin to accomplish this, 3 critical near-term goals need to be met. Each is driven by our longstanding mission to reduce disability and death from cardiovascular disease and stroke.
The first goal targets our patients and people at risk. It states that by 2003, we will double the percentage of people who will effectively reduce their risk factors to the goal levels established by the American Heart Association in collaboration with our other public health partners. The second goal states that by 2003, the percentage of patients suffering from sudden death, acute myocardial infarction, or stroke who receive the appropriate treatment within the recommended time frame from the onset of symptoms will increase significantly, with specific goals for each disease entity. The last goal is to maximize the scientific, human, and financial resources of the association to make the attainment of the other goals possible.
As we looked forward, the American Heart Association recognized the value in building relationships with like-minded health organizations as a means of achieving our common goals. These relationships not only provide access to a wider spectrum of resources, but also provide the means to communicate vital information to the public more effectively.
Because the goals of our association are in direct alignment with those of the Department of Health and Human Services’ Healthy People 2010 initiative,1 this seemed a logical place to forge a partnership.
Healthy People 2010 is a national health promotion and disease prevention initiative that aims to bring together national, state, and local government agencies; nonprofit, voluntary, and professional organizations; businesses; communities; and individuals to improve the health of all Americans, to eliminate disparities in health, and to improve quality of life. A strategic partnership made up of this broad base of knowledge, information, and resources offers extensive possibilities for public health professionals and individual practitioners in their efforts to prevent and treat disease. It is our hope that the American Heart Association’s early and active participation in this partnership will foster our own strategic goals and model such relationships for other organizations.
We live in an information-driven society that offers an infinite number of health messages to the public. Through new technology, this information, whether useful or misleading, takes only an instant to retrieve. Even when the messages are accurate, this overflow of information can be confusing and overwhelming to the consumer. A widespread sharing of information among the nation’s foremost health organizations and the coordination of our messages has the potential to provide far more consistent information to the public and to health professionals.
In February 2001, a Regional Cardiovascular Health Summit was held in New York City. Along with representatives from the 4 federal health agencies of the Healthy People 2010 Strategic Partnership, I had the privilege of signing a Memorandum of Understanding outlining a strategic alliance that will bring together the individual strengths of each organization for the benefit of all. This agreement is truly a milestone in public and private sector cooperation.
Joining with the American Heart Association in signing this Memorandum of Understanding was Dr David Satcher, Surgeon General; Dr Randolph F. Wykoff, Deputy Assistant Secretary for Health for the Office of Public Health and Science; Dr James S. Marks, Director of the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention; Dr Claude Lenfant, the Director of the National Heart, Lung, and Blood Institute; and Dr Gerald D. Fischbach, the Director of the National Institute of Neurological Disorders and Stroke. We anticipate that the Health Care Financing Administration and the National Institute on Aging will also be signing the Memorandum at a later time.
Surgeon General David Satcher stated that, "This historic Memorandum of Understanding will create a working partnership that promises to greatly improve the nation’s cardiovascular health by the year 2010."
Dr Audrey S. Penn, Acting Director of the National Institute of Neurological Disorders and Stroke, emphasized the positive impact this partnership will have on current barriers to the effective treatment of stroke. "The complex challenge of stroke prevention, treatment, and rehabilitation demands that the American public know the risk factors for stroke, as well as the warning signs and symptoms of stroke and the need to take immediate action. A powerful way to combat public and sometimes even medical indifference is to form close, collaborative partnerships with groups which have similar priorities and concerns."
After reviewing the Health Care Financing Administration data on Medicare recipients hospitalized with coronary disease, Dr Steve Jencks, Director of Quality Improvement Standards, defined a large treatment gap in guideline-based treatment.2 He has expressed enthusiasm about the American Heart Association’s capability, through the Get with the Guidelines program, to partner with state peer review organizations to help physicians and other quality improvement personnel improve performance in hospitals.
Information-Based Technology and Other Partnerships
In the continued spirit of partnering, the American Heart Association has also formed a strategic alliance to further strengthen our relationship with the American College of Cardiology. The 2 organizations have worked together over the years to codevelop multiple guidelines on the primary and secondary prevention and treatment of cardiovascular disease. Our enhanced alliance will enable each organization to extend its reach beyond what could be accomplished individually.
A leadership group, consisting of 8 representatives from each organization, will appoint advisory boards and working groups that will assume responsibility for specific initiatives and examine new joint opportunities. The first advisory board selected will be responsible for implementing a Web-based professional education program that both organizations will help develop and endorse. The mission of this project is to provide the single most credible digital source of cardiovascular information and education for healthcare professionals. A subsequent working group will develop an analogous site for patients and the public.
Within this partnership, each organization will maintain its separate identity, and each will have other professional education and patient education programs. This agreement does not preclude other initiatives with third parties. Still, there is great credibility and strength in the combined knowledge base and endorsement of these 2 organizations, and the partnership will take advantage of this strength.
Public Advocacy
Public advocacy plays a significant role in directing the attention of our decision-makers to the key issues that impact cardiovascular disease and stroke. The American Heart Association partners with a wide variety of organizations and participates in many coalitions that advance our public policy and legislative priorities.
To address tobacco control issues, we work closely with the Campaign for Tobacco-Free Kids, the American Cancer Society, and the American Lung Association, as well as the 50 members of the Effective National Action to Control Tobacco (ENACT) Coalition. A key priority is our advocacy for full Food and Drug Administration regulatory authority over the manufacture, labeling, marketing, and promotion of one of the nation’s deadliest products: tobacco.
By working with groups such as Research!America and the Campaign for Medical Research, the association advocates for federal research funding initiatives. A primary focus is to double the budget for the National Institutes of Health by fiscal year 2003. This will achieve significant growth in federal funding for the National Heart, Lung, and Blood Institute, the National Institute of Neurological Disorders and Stroke, and for the other components of the National Institutes of Health that support basic, clinical, and population research critical to our mission.
In addition, through our partnership with the Congressional Heart and Stroke Coalition, we sponsor briefings for both the House and Senate on the importance of support for heart and stroke research. The American Heart Association spearheaded the formation of the coalition, which now numbers 160 representatives and 52 senators. In addition, the association formed and manages the National Coalition for Heart and Stroke Research. The coalition consists of 14 national organizations representing >5 million volunteers and members united in support of increased funding for heart and stroke research.
Another focus for the association is our acute event messaging and support for rapid and effective treatment of acute myocardial infarction, sudden cardiac arrest, and stroke.3 We consistently consult with emergency physicians, emergency medical service directors, police and fire organizations, the American Red Cross, and with our first-line automated external defibrillator (AED) manufacturers on AED/cardiopulmonary resuscitation and acute care policy issues and legislation. Last year, our collective efforts resulted in the passage of the Cardiac Arrest Survival Act to promote AED/cardiopulmonary resuscitation training and AED availability in federal buildings. The recent Federal Aviation Administration rule requiring AEDs on all commercial aircraft was also encouraged by this coalition.
The National Coalition to Promote Physical Activity and the Governors’ Council on Physical Fitness have become our advocacy allies on physical activity. We also work with the Center for Science in the Public Interest and the National Alliance of Nutrition and Activity on nutrition. The collective efforts and active support of these partnerships resulted in the passage of the Physical Education for Progress Act. Under this program, the Secretary of Education has developed application guidelines and can award grants to help initiate, expand, and improve physical education programs for students in kindergarten through 12th grade. The association advocates policies that promote physically active lifestyles. Schools and communities are encouraged to offer opportunities to promote physical activity among children and adults.
We also partner with organizations to further the fight against stroke. This year, we have a unique opportunity to lead an effort to build support for far-reaching stroke legislation, the Stroke Treatment and Ongoing Prevention Act (STOP Stroke Act), which was initiated by Senator Edward Kennedy. We are now in the process of identifying interested partners in support of the passage of this proposed legislation. The American Stroke Association, a division of the American Heart Association, collaborates with the American Academy of Neurology, the Brain Attack Coalition, and other interested organizations to raise awareness on stroke issues.
The American Heart Association has also taken a leadership role in forming a new coalition, Research to Prevention, with the American Cancer Society, the American Diabetes Association, the Epilepsy Association, the Arthritis Foundation, and other chronic disease organizations. The purpose of this coalition is to advocate for the Centers for Disease Control and Prevention’s chronic disease programs, such as its Cardiovascular Health Programs.
To maintain an active role in nonprofit-related and tax policy issues, the American Heart Association works closely with Independent Sector, a membership association of >500 health, education, arts, and philanthropic groups.
To promote increased coverage for patients who need heart and stroke-related preventive, acute, and rehabilitative services, we are actively seeking to expand our Washington, DC, advocacy partners to include organizations that represent important constituencies, such as American Association of Retired Persons, the National Council of La Raza, and the Congressional Black Caucus Foundation.
Taking a proactive stance to cultivate ongoing relationships with partners of the Healthy People 2010 initiative and other advocacy and technology-based collaborations will bring about exponential growth in our ability to provide information and services to the public. This will allow the American Heart Association to better serve our 22.5 million volunteers and supporters, as well as the many consumers who look to our association for cardiovascular and stroke health resources.
Footnotes
The opinions expressed in this editorial are not necessarily those of the editors or of the American Heart Association.
References
1. US Dept of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: US Dept of Health and Human Services; 2000.
2.
Jencks SF, Cuerdon
T, Burwen DR, et al. Quality of medical care delivered to Medicare
beneficiaries: a profile at state and national levels.
JAMA. 2000;284:1670–1676.
3. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 102(suppl):I-1–I-384.
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