At the 35th Annual Legislative Conference, the National Black Caucus of State Legislators (NBCSL) ratified two resolutions recognizing the importance of the ongoing fight against heart disease and stroke in women. NBCSL unanimously supported Friday, February 3, 2012, as “National Wear Red Day,” (HHS-12-16) and (HHS-12-08), while simultaneously recognizing the monumental need for “A Call to Action” to devise strategies that emphasize warning signs, taking into account socioeconomic factors, cultural barriers, and lifestyle choices for those women at highest risk.

Background

Cardiovascular disease has claimed the lives of nearly 500,000 American women each year. Cardiovascular disease is the nation’s number one killer of men and women across all racial and ethnic groups. As the leading cause of death for all Americans, heart disease contributes to rising health care costs. In fact, one-third of the nation's population lives with some form of cardiovascular disease. In 2010, the total cardiovascular disease medical costs were an estimated $300 billion, according to the Centers for Disease Control and Prevention. Research has shown disparities between minority racial/ethnic groups and whites facing the risk of heart disease. Heart disease is more prevalent among African American women than white women—as are some of the factors that increase the risk of developing it, including high blood pressure, overweight and obesity, and diabetes. In addition to having higher heart disease rates, African American women die from heart disease more often than all other Americans.

What African American Women Should Know About Heart Disease

The Facts - Heart Disease and African American Women

• Cardiovascular disease is the leading cause of death for African American women 20 years of age and older.
• African American women have a higher risk of cardiovascular disease than Caucasian women and are less aware of their cardiovascular risk factors.
• For African American women over the age of 18, the rate of coronary heart disease is directly related to education, income, and poverty status.

Risk Factors - Obesity, Diabetes, and High Blood Pressure

• Two-thirds of all African American women are either overweight or obese.
• Diabetes, the fastest-growing risk factor for heart disease in this country, is more prevalent among African American women than Caucasian women.
• 9% of Caucasian women between the ages of 45 and 54 have diabetes compared to 15% of African American women. The difference is even higher between ages 55 and 64 for which 15% of Caucasians have diabetes compared to 30% for their African America counterparts.
•  The death rate from diabetes is 167% higher for African American women than Caucasian women.
• Even a slightly higher level of diabetes doubles the risk of heart disease. Twice as many African American women have higher blood pressure than Caucasian women, significantly increasing the risk of heart disease. Diet, lifestyle, stress, and exercise all factor into high blood pressure rates.

Federal Action

The Affordable Care Act Addresses Heart Disease and Preventative Measures

For most people, heart disease and stroke can be prevented through lifestyle and behavioral changes. Early detection and treatment is imperative to reducing the risk of heart disease and stroke. As part of health reform, the Affordable Care Act (ACA) requires new health plans to cover a number of preventive services at no cost, including many that can help reduce risk of cardiovascular disease, such as:

• Screening for obesity and (dietary) counseling from your doctor and other health professionals to promote sustained weight loss;
• Blood pressure screening;
• Counseling on the use of daily aspirin to reduce the risk of a stroke; and
• Tests to screen for high cholesterol and diabetes.

The ACA established a National Prevention, Health Promotion, and Public Health Council, composed of senior officials across the government, to elevate and coordinate prevention activities and design a focused strategy across departments to promote the nation’s health. On June 10, 2010, President Barack Obama signed an Executive Order creating the National Prevention Council.

In addition, ACA created a new Prevention and Public Health Fund designed to expand and sustain the necessary infrastructure to prevent heart disease, detect it early, and manage conditions before they become severe. This new initiative will increase the national investment in prevention and public health, improve health, and enhance health care quality.

CDC’s Heart Disease and Stroke Prevention Programs

Since 1998, the Centers for Disease Control and Prevention (CDC) has funded state health departments' efforts to reduce the number of people with heart disease and stroke. Health departments in 41 states and the District of Columbia are currently receiving funding. The National Heart Disease and Stroke Prevention Program stresses policy and education to promote heart-healthy and stroke-free living and working conditions.

The WISEWOMAN (Well-Integrated Screening and Evaluation for WOMen Across the Nation) program provides low-income, under-insured, or uninsured women with chronic disease risk factors screening, lifestyle intervention, and referral services in an effort to prevent cardiovascular disease.

CDC funds 21 WISEWOMAN programs, which operate on the local level in states and tribal organizations. WISEWOMAN programs provide standard preventive services including blood pressure and cholesterol testing. From July 2008 to June 2010, WISEWOMAN has accomplished the following:

• Provided almost 78,000 screenings to women for heart disease and stroke risk factors. 89% of WISEWOMAN participants were found to have one or more risk factors for heart disease and stroke; and
•  Provided health care referrals to all participants who needed them and more than 43,000 women or about 61% of women screened participated in at least one lifestyle intervention session. During this time, the number of women participating in lifestyle interventions increased by 55%.

State Action

States have enacted programs using federal and state funds, and have partnered with public health organizations to promote awareness, increase early-detection and screening, provide affordable or no-cost treatments to vulnerable populations, and identify preventative measures for the millions of Americans living with heart disease. Since state governments cover all or partial costs for their state employees and Medicaid enrollees with heart disease, investing in preventative measures and chronic disease management programs ultimately proves to be cost effective and prudent. A number of lawmakers across the country have answered this “Call to Action” by introducing legislation, engaging in community outreach, and participating in heart disease awareness campaigns.

RHODE ISLAND

Women's Cardiovascular Screening and Risk Reduction Pilot Program RI HB 5173/ SB 60 (Sens. Elizabeth A. Crowley, Frank A. DeVall, Jr., Rhoda E. Perry, Joshua Miller, and V. Susan Sosnowski)

Summary: Directs the Department of Health to develop a cardiovascular disease screening and lifestyle intervention pilot program administered out of six core cities (non-residents may travel to those cities to participate). This legislation allows Rhode Island to participate in CDC’s WISEWOMAN program.

Background: Rhode Island noted the success other states had had in participating in CDC’s WISEWOMAN program and concluded the best chance for women in the state to reduce their mortality rates due to cardiovascular disease was through education and prevention. Unable to provide service access to all women throughout the state meeting income and other criteria where they live, this fiscal compromise allows Rhode Island to concentrate service access in relatively few locations. Proponents anticipate that the pilot will be successful and position them to make the case for a permanent--and permanently funded--program.

Goals:

• Target vulnerable populations including low-income, under-insured, and uninsured women between 40 and 64 years of age who are at risk for heart disease, diabetes, and stroke;
• Maintain specified measures to gauge the impact and outcome of the program; and
• Identify and track key benchmarks to include the number of women served, the number receiving lifestyle interventions, the number of follow-up visits per woman, evaluation of the use of progress markers to reduce risk factors, and a research and evaluation component.

Concern:

• The pilot program expires three years after implementation, thus limiting long-term access to screening, prevention, and care.

DELAWARE

Heart Disease and Stroke Prevention Program DE S 66/84 (Sens. Bethany Hall-Long, Margaret Rose Henry*)

Summary: Establishes a Cardiovascular Disease and Stroke Prevention Program within the Division of Public Health to reduce the incidences of cardiovascular disease and stroke in Delaware through the creation of a state program to promote health education, public awareness, and community outreach activities, and to improve access to treatment for and prevention of cardiovascular disease and stroke.

Background: Cardiovascular disease is the leading cause of death in Delaware, and stroke is the third leading cause of death. To combat these sobering figures, Delaware established a program to specifically address the needs of those living with heart disease or stroke-related health issues.

Goals:

• Conduct health education, public awareness, and community outreach activities that relate to primary and secondary prevention of cardiovascular disease and stroke;
• Provide health care providers, employers, schools, community health centers, and other targeted stakeholders with innovative and effective programs that achieve the objectives of improved treatment, prevention, and public awareness;
• Issue guidance regarding the roles and responsibilities of government agencies, health care providers, employers, third-party payers, patients, and families of patients of best practices in the treatment, primary and secondary prevention, and public awareness of cardiovascular disease and stroke;
• Improve access to treatment for primary and secondary prevention of heart and cardiovascular disease and stroke through public awareness programs and campaigns, including access for uninsured individuals and individuals living in rural or underserved areas; and
• Assist communities in developing comprehensive local cardiovascular disease and stroke prevention programs.

Concern:

• Due to budget constraints, the General Assembly may not set aside or maintain funding for the program, thereby stripping the authority of the Division of Public Health to address heart disease and stroke-related illnesses.

MISSOURI

Women's Heart Health Program H 1898 (Reps. Anne Zerr, Tishaura Jones*, Sharon Pace*, Sens. S. Kiki Curls*, Maria Chappelle-Nadal*)

Summary: Establishes the Women's Heart Health Program within the Department of Health and Senior Services to provide heart disease risk screenings for women who are between 35 and 64 years of age, who are uninsured or under-insured, or have a gross family income at or below 200% of the federal poverty level.

Background: The Show Me Healthy Women (SMHW) is a free breast and cervical cancer screening program for Missouri women of a certain age, income, and insurance coverage. The objective of the SMHW program is to offer screening services to women who fall under the high risk category. High risk women include, but are not limited to, low-income women, women over 50, women with no or little insurance, women who have rarely or never been screened, women living in rural areas, women of color, and women with disabilities. More recently, due to the increase of women living with heart disease and stroke-related illnesses, the state expanded the SMHW program to include coverage for heart disease screenings.

Goals:

• Promote awareness and encourage screening for heart disease;
• Offer free heart disease risk screenings to vulnerable populations of women of certain criteria who are deemed high risk;
• Contract with health care providers who provide services under the Missouri Show Me Healthy Women Program; and
• Require a woman whose screening indicates an increased risk for heart disease to be referred for the appropriate follow-up health care services and be offered lifestyle education services to reduce her risk for heart disease.

Concerns:
The state is dependent on federal funding for the operation of this program; and if federal funds are not received, the department is not required to implement the program, thereby eliminating free heart disease screenings for those women deemed high risk.

National Supporters and Resources

The American Heart Association whose mission it is to build healthier lives, free of cardiovascular diseases and stroke.

Go Red For Women™ is an international awareness campaign dedicated to the prevention, diagnosis, and control of cardiovascular disease in women. The movement harnesses the energy, passion, and power women have to band together and collectively wipe out heart disease. It challenges them to know their risk for heart disease and to take action to reduce their personal risk. It also gives them the tools they need to lead a heart healthy life.

Healthy People 2020 is the federal government's prevention agenda for building a healthier nation. The initiative provides science-based, 10-year national objectives for improving the health of all Americans. For three decades, Healthy People has established benchmarks and monitored progress over time to encourage collaborations across communities and sectors; to empower individuals toward making informed health decisions; and to measure the impact of prevention activities.

The Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention works to improve cardiovascular health through public health strategies and policies that promote healthy lifestyles and behaviors; healthy environments and communities; and access to early and affordable detection and treatment.

The National Heart, Lung, and Blood Institute (NHLBI) provides global leadership for a research, training, and education program to promote the prevention and treatment of heart, lung, and blood diseases, and enhance the health of all individuals so that they can live longer and more fulfilling lives. The Institute collaborates with patients, families, health care professionals, scientists, professional societies, patient advocacy groups, community organizations, and the media to promote the application of research results and leverage resources to address public health needs.

The * denotes National Black Caucus of State Legislators member