By Claude-Alix Jacob, MPH, NACCHO President and Chief Public Health Officer for the Cambridge Public Health Department (MA)
The burden of cardiovascular disease poses significant risk to the health and well-being of our communities. Heart disease is the leading cause of death for both men and women in the United States. According to the CDC, approximately 610,000 Americans die from heart disease—one in every four deaths. Someone dies from a heart disease-related event every minute in the United States.1 These statistics have dire consequences for the quality of life and vitality of our populations. Our nation also experiences these consequences economically: Heart disease costs the United States about $207 billion each year in healthcare services, medications, and lost productivity.1
February is American Heart Month, a time for local health departments (LHDs) to reflect on the burden of cardiovascular disease in their communities and recommit to chronic disease prevention. Sponsored by the American Heart Association, the month aims to raise awareness about heart disease and how to prevent it. February is also Black History month, an opportunity for LHD leaders and staff to raise awareness about how cardiovascular disease affects the black community. Cardiovascular diseases are the leading cause of death for African-American women, killing more than 48,000 annually. According the American Heart Association, 48% of African-American women and 46% of African-American men have some form of cardiovascular disease. The coincidence of these two events is particularly important.
Three Innovative Approaches to Chronic Disease Prevention
While the statistics are sobering, LHDs work every day to prevent chronic disease and decrease the incidence of heart disease, particularly among groups with the highest risk. NACCHO recognized several of their accomplishments through the 2016 Model Practices Program.
The Oklahoma City-County Health Department focused on improving chronic disease-related health outcomes for residents in its zip codes with the greatest health inequities, which included communities with high concentrations of African-American and Hispanic residents. The department implemented a multi-pronged place-based approach to address systems, environments, and behavior in the areas of physical activity, nutrition, chronic disease, and access to healthcare. Its “My Heart” program provided chronic disease prevention and management tools to 200 clients annually, with impressive results: In the year-long My Heart program, participants achieved a nearly 7% decrease in Body Mass Index, a 400% increase in physical activity, a 21% decrease in tobacco use, and an 8% decrease in average total cholesterol.
The Northeast Texas Public Health District won a NACCHO Model Practices Award for its innovative approach to reducing high cholesterol, blood pressure, and glucose levels among local high-risk African-American and Hispanic residents. Recognizing that these populations often lacked access to medical services and programs necessary to overcome health inequities, the department partnered with other local entities to create the Center for Health Living in Tyler, TX. Located in an abandoned fire station, the Center encouraged its community to become “fired up for prevention.” The Center provides chronic disease self-management, free glucose, cholesterol, blood pressure and BMI screenings, nutrition and cooking classes, health assessments, tobacco cessation information and classes, primary care referrals, navigation services, and other evidence-based programs. Evaluation of the program demonstrated the efficacy of the interventions: On average, after one year in a health education or diabetes self-management class at the Center, participants decreased their glucose numbers by 16 points; systolic blood pressure by 17 points; diastolic blood pressure by eight points; and total cholesterol by 12 points.
Chronic disease prevention has been an important focus for my own health department, the Cambridge Public Health Department. Our Cambridge in Motion program aims to create an environment that makes it easier for residents and people who work in our city to eat healthy and be physically active. Our two-pronged approach focuses on health eating and active living. We have increased the number of convenience stores that offer and promote healthy foods and beverages; improved the nutritional quality of foods and beverages served in our schools; and increased access to farmers’ markets for our low-income residents. Through partnerships with the Cambridge Community Development Department, we have increased opportunities for physical activity through a bike-sharing program and created streets that work well for walking and bicycling using a “Complete Streets” approach. We also partnered with local Whole Foods Market stores to co-fund nutrition and physical activity mini-grants to local organizations to help them develop activities that promote our chronic disease prevention goals.
Another Cambridge initiative, the Men’s Health League, aims to prevent cardiovascular disease and type 2 diabetes among men in the city—particularly men of color, who are disproportionately affected by cardiovascular disease and type 2 diabetes. The Men’s Health League has three core programs designed to increase physical activity, support healthy eating, and educate men about important health topics. The program has been widely successful, winning a NACCHO Model Practice Award in 2010.
NACCHO’s Chronic Disease Prevention Program
NACCHO has developed a suite of tools and resources to help LHDs address heart disease, stroke, and other chronic diseases. Most recently, NACCHO worked with Association of State and Territorial Health Officials (ASTHO) to support the Centers for Disease Control and Prevention’s Million Hearts project. NACCHO and ASTHO co-hosted three technical assistance webinars on topics including how health departments can promote Million Hearts and facilitate community-clinical linkages for cardiovascular disease prevention. NACCHO also developed a fact sheet about working with faith-based communities to promote chronic disease prevention and provided targeted technical assistance to LHDs about the Million Hearts campaign.
NACCHO’s development enterprise, The Foundation for the Public’s Health, has begun working with WomenHeart, the national coalition for women with heart disease. In 2015, NACCHO established The Foundation to fill a critical void in the public health system by creating a culture and practice of philanthropic giving to support the critical work of LHDs. In the latter half of 2016, The Foundation began exploring ways to mobilize funds to support WomenHeart in their mission to improve the health and quality of life for women living with or at risk of heart disease.
I encourage LHD leaders and staff to use take advantage of this opportunity to raise awareness about cardiovascular disease in their communities. Below you’ll find helpful resources to help guide your efforts this month and throughout the year. I look forward to learning about the new and innovative efforts LHDs are implementing to move the needle in this critical area of public health.
Resources
NACCHO
Cardiovascular Health Webpage
http://www.naccho.org/programs/community-health/chronic-disease/cardiovascular
NACCHO’s Model Practices Database (use Search Category box and check Chronic Disease)
http://archived.naccho.org/topics/modelpractices/search.cfm
Fact Sheet: Working with Faith Communities to Address Heart Disease and Stroke Inequities
http://eweb.naccho.org/prd/?na711pdf
Million Hearts Local Engagement Guide
http://eweb.naccho.org/prd/?na612pdf
Fact Sheet: Sustaining Health Food Retail Initiatives
http://eweb.naccho.org/prd/?na724pdf
Fact Sheet: Million Hearts: Practice-Based Successes in Sodium Reduction in Local Communities
http://eweb.naccho.org/ord/?na671pdf
Issue Brief: Local Health Department Role in Preventing and Reducing Obesity and Chronic Diseases among Children and Youth
http://eweb.naccho.org/prd/?na549pdf
NACCHO’s Big Cities Health Coalition – Chronic Disease and Tobacco
http://www.bigcitieshealth.org/regulating-e-cigarettes-bchc/
Others
American Heart Association
http://www.heart.org/HEARTORG/
American Heart Month Resources
https://healthfinder.gov/nho/FebruaryToolkit.aspx
Cambridge Men’s Health League
http://www.cambridgepublichealth.org/lifestyle/mens-health/index.php
CDC Division for Heart Disease and Stroke
https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_disease.htm
References
- Mozzafarian, D., Benjamin, E. J., Go, A. S., et al. on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics – 2015 Update: A report from the American Heart Association. Circulation. 2015;131:e29-e322.
- Mozzafarian, D., Benjamin, E. .J, Go, A. S., et al. on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2016 update: A report from the American Heart Association. Circulation. 2016;133:e38-e360.
