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C A Public Health Action Plan to Prevent  Heart Disease and Stroke RECOMMENDATIONS To help the public health community implement the Action Plan, spe- cific recommendations were developed by five Expert Panels. These pan- els addressed the five essential components of the plan—taking action, strengthening capacity, evaluating impact, advancing policy, and engaging in regional and global partnerships. Their work was synthesized by a Work- ing Group into 22 recommendations, which are presented here according to the Expert Panel that produced them. Taking Action: Putting Present Knowledge to Work 1. Initiate policy development in CVH promotion and CVD preven- tion at national, state, and local levels to assure effective public health action against heart disease and stroke. In addition, eval- uate policies in non-health sectors (e.g., education, agriculture, transportation, community planning) for their potential impact on health, especially with respect to CVD. 2. 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 209

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210 APPROACH TO PREVENT AND CONTROL HYPERTENSION 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 pro- gram evaluation and prevention research and a growing inventory of “best practices.” 3. Address all opportunities for prevention to achieve the full po- tential 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), and whole populations, particularly priority populations (based on race/ethnicity, sex, disability, economic condition, or place of residence). 4. Emphasize promotion of desirable social and environmental con- ditions and favorable behavioral patterns in order to prevent the major CVD risk factors and assure the fullest attainable accessibil- ity and use of quality health services for people with risk factors or who develop subclinical or overt CVD. These actions are integral to a comprehensive public health strategy for CVH promotion and CVD prevention. Strengthening Capacity: Transforming the Organization and Structure of Public Health Agencies and Partnerships 5. Maintain or establish definable entities with responsibility and accountability for CVH programs within federal, state, and local public health agencies, including laboratory components. 6. Create a training system 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 change and implement programs to improve CVH promotion and decrease the CVD burden, including laboratory requirements. 7. Develop and disseminate model performance standards and core competencies in CVD prevention and CVH promotion for na- tional, state, and local public health agencies, including their laboratories. 8. Provide ongoing access to technical assistance and consultation to state and local health agencies and partners for CVD prevention.

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211 APPENDIX C Evaluating Impact: Monitoring the burden, Measuring Progress, and Communicating urgency 9. Expand and standardize population-wide evaluation and surveil- lance data sources and activities to assure adequate assessment of CVD indicators and change in the nation’s CVD burden. Ex- amples include mortality, incidence, prevalence, disability, selected biomarkers, risk factors and risk behaviors, economic burden, community and environmental characteristics, current policies and programs, and sociodemographic factors (e.g., age, race/ethnicity, sex, and ZIP code). 10. Establish a network of data systems for evaluation of policy and program interventions that can track the progress of evolving best practices and signal the need for changes in policies and programs over time. This network would support the full development, collection, and analysis of the data needed to examine program effectiveness. 11. Develop the public health infrastructure, build personnel compe- tencies, and enhance communication systems so that federal, state, and local public health agencies can communicate surveillance and evaluation results in a timely and effective manner. Advancing Policy: Defining the Issues and Finding the Needed Solutions 12. Conduct and facilitate research by means of collaboration among interested parties to identify new policy, environmental, and so- ciocultural priorities for CVH promotion. Once the priorities are identified, determine the best methods for translating, disseminat- ing, and sustaining them. Fund research to identify barriers and effective interventions in order to translate science into practice and thereby improve access to and use of quality health care and improve outcomes for patients with or at risk for CVD. Con- duct economics research, including cost-effectiveness studies and comprehensive economic models that assess the return on invest- ment for CVH promotion as well as primary and secondary CVD prevention. 13. Design, plan, implement, and evaluate a comprehensive interven- tion for children and youth in school, family, and community set- tings. This intervention must address dietary imbalances, physical inactivity, tobacco use, and other determinants in order to prevent development of risk factors and progression of atherosclerosis and high blood pressure.

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212 APPROACH TO PREVENT AND CONTROL HYPERTENSION 14. 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. Ad- dress population subgroups in various settings (schools, work sites, health care, and communities) at local, state, and national levels. Additionally, assess the impact of new technologies and regulations on surveillance systems and the potential benefit of alternative methods. 15. Conduct and support research to determine the most effective mar- keting 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 evalu- ate economically viable CVD prevention ventures (e.g., in food production, manufacturing, marketing). 16. 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. Engaging in Regional and Global Partnerships: Multiplying Resources and Capitalizing on Shared Experience 17. Engage with regional and global partners to mobilize resources in CVH promotion and CVD prevention, develop and implement global CVH policies, and establish or strengthen liaison with the partners identified in these recommendations. 18. 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. 19. Develop a strategy to promote use of the media to support. 20. 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 nontra- ditional partners—in a systematic and strategic approach. 21. Strengthen the global focus of public health agencies in the United States and their partners on CVH and increase their participation in partnerships intended to a) develop and implement standards for adequate monitoring of health, social, and economic indicators

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21 APPENDIX C and b) develop the ability to effectively disseminate and translate information into policy and action. 22. Promote and support research on implementing and evaluating CVH policy interventions in diverse settings where different social and economic development and health transition experiences offer contrasting conditions for testing new intervention approaches.

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