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6 Implementing a Population-Based Policy and Systems Approach to the Prevention and Control of Hypertension
Pages 175-198

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From page 175...
... , through the Division for Heart Disease and Stroke Prevention (DHDSP) , has leveraged its broader cardiovascular disease prevention and control programmatic 1
From page 176...
... Objectively, however, there are two significant problems with the current status and direction of hypertension prevention and control activities: • ypertension is only one component of a larger cardiovascular H disease prevention program that has more of a medical care rather than a population-based prevention focus. • he CDC's cardiovascular disease program in general, and the T hypertension program in particular, are dramatically under funded relative to the preventable burden of disease and the strategy and action plan that have been developed.
From page 177...
... In the next section the committee makes recommendations for state and local health jurisdictions, including necessary resources and accountability measures to support the recommended population-based policy and systems approach to preventing and controlling hypertension. RECOMMENDATIONS FOR STATE AND LOCAL HEALTH JuRISDICTIONS State and local governments have specific roles and responsibilities for protecting, preserving, and promoting the public's health.
From page 178...
... should lead SLHJs to assess and, if necessary, modify these programs to assure they are relevant and accessible to older and higher-risk populations. 6.2 The committee recommends that state and local public health jurisdictions integrate hypertension prevention and control in pro grammatic efforts to effect system, environmental, and policy changes that will support healthy eating, active living, and obesity prevention.
From page 179...
... The NSRI's strategy includes working with the food industry to set sodium reduction targets for their products that are substantive, achievable, gradual, measurable, and voluntary, with the goal of reducing population sodium intake by 20 percent over 5 years. The process for implementing the strategy includes meeting with food industry leaders to discuss sodium reduction, working with packaged food manufacturers and restaurants to set voluntary sodium targets by food category, implementing targets and timelines to reduce salt, and monitoring the salt reduction process through the creation of restaurant and packaged food nutrition databases.
From page 180...
... SLHJs without the resources to implement a state-level HANES may need to identify other reliable population-based data sets, for example, health care quality reporting data, that could be used to monitor local hypertension trends. 6.4 The committee recommends that state and local public health jurisdictions assess their capacity to develop local HANES as a means to obtain local estimates of the prevalence, awareness, treatment, and control of hypertension.
From page 181...
... Assuring complementary lifestyle interventions (physical activity, weight management, healthy diet) in health care treatment protocols and linking these activities to community-based strategies through community health workers may be another important element of a local hypertension control program.
From page 182...
... The committee notes, in fact, there are fewer public health resources for hypertension prevention than for any other preventable risk factor underlying a disease burden of comparable magnitude. As an example, CDC funding for the Office on Smoking and Health is $106.2 million while funding for the Division for Heart Disease and Stroke Prevention is $54.1 million; this funding supports activities related to not only hypertension but also stroke and cardiovascular disease in general.
From page 183...
... To effectively support the change and maintain a population-based focus, new expertise and guidance may be required beyond that which may be available through the DHDSP's partnership with the National Forum for Heart Disease and Stroke Prevention. 6.10 The committee recommends that the Division for Heart Disease and Stroke Prevention identify and work with experts grounded in population-based approaches to provide guidance and assistance in de signing and executing hypertension prevention and control efforts that focus on population-based policy and system change.
From page 184...
... Improved blood pressure control, especially systolic blood pressure among the elderly, would be the result of strategies designed to address the factors contributing to poor physician adherence to JNC treatment guidelines. The effect of removing economic barriers to effective antihypertensive medications and employing the use of community health workers to provide community-based support for individuals with hypertension would be improved access to medications and supportive hypertension care for vulnerable populations.
From page 185...
... As such, it is a potential sentinel indicator for assessing and testing broader approaches to reduce health disparities. Hypertension is a condition strongly influenced by underlying individual and community risk factors related to healthy eating and active living -- risk factors driven by race and class in most communities today.
From page 186...
... Recommendations to Enhance Population-Based Efforts and to Strengthen Efforts Among CDC Units and Partners Short-Term Outcomes (or process input or Intermediate Priority Recommendation outputs) Short-Term Indicator Outcomes Intermediate Indicators 4.1 The DHDSP should integrate Better targeting Budget allocated to Reduction of Prevalence of hypertension prevention and control in and integration population-based hypertension risk overweight/obesity programmatic efforts to effect system, of hypertension policy and system factors in the environmental, and policy changes prevention in approaches by the population Proportion of individuals through collaboration with other other CDC unit CDC who consume a healthy CDC units and their external partners.
From page 187...
... elements and focus to nonhypertension programs 6.2 SLHJs should integrate Strong federal, Number of SLHJs hypertension prevention and control in state, and local with comprehensive programmatic efforts to effect system, public health agency programs for environmental, and policy changes leadership that gives population that will support healthy eating, active priority to reducing hypertension control living, and obesity prevention. Existing the prevalence of programs and new programmatic efforts should hypertension through be assessed to ensure they are aligned population-based with populations, most likely to be approaches integrated affected by hypertension such as older throughout agency populations, which are often not the activities target of these programs.
From page 188...
... for the general population implementation of local budgets and of hypertension and 1,500 mg/day (equivalent to 70 federal, state, land plans for programs to mmol/day) for blacks, middle-aged ocal programs to reduce sodium intake and older adults, and individuals with reduce sodium intake hypertension.
From page 189...
... Reduction of hypertension risk factors in the population continued 19
From page 190...
... at the understudied populations including: national, state, and children, racial and ethnic minorities, local levels the elderly, and socioeconomic groups. 6.4 SLHJs should assess their Increased number of Number of states Access to local data Number of states capacity to develop local HANES as state and localities and localities with on hypertension and localities that are a means to obtain local estimates of with a NHANES-like data systems that trends implementing program the prevalence, awareness, treatment, survey provide estimates changes based on local and control of hypertension.
From page 191...
... 4.6 The DHDSP and other CDC Improved systems Availability of data Data on high-sodium- Percent of high content units, should explore methods for measuring or on specific foods containing foods are sodium products that to develop and implement data- estimating sodium that are important tracked and used to have reduced their sodium gathering strategies that will allow content in food contributors to develop strategies for content for more accurate assessment and are designed and dietary sodium intake reduction tracking of specific foods that are implemented by the American important contributors to dietary people sodium intake by the American people. 4.7 The DHDSP and other CDC Improved systems Availability of Data on dietary Reduction in mean dietary units should explore methods for measuring or mean population sodium consumption sodium intake to develop and implement data- estimating dietary dietary sodium and are available and gathering strategies that will allow sodium and potassium intake at used to target dietary for more accurate assessment and potassium intake the national, state, sodium reduction the tracking of population-level are designed and and local levels programs dietary sodium and potassium intake implemented including the monitoring of 24-hour urinary sodium and potassium excretion.
From page 192...
... Once these factors guidelines according to JNC systolic blood are better understood, strategies guidelines pressure control should be developed to increase the Targeted strategies among the elderly likelihood that primary providers to improve Proportion of will screen for and treat hypertension provider awareness, providers who follow appropriately, especially in elderly understanding, JNC pharmacologic patients. acceptance, and therapies for adherence to JNC treatment of treatment guidelines hypertension
From page 193...
... to develop physician groups, a plan to engage and leverage skills purchasers of and resources for improving the health care services, medical treatment of hypertension quality improvement organizations, and employers around hypertension prevention and control continued 19
From page 194...
... hypertension control, medication regimens The DHDSP should work with the especially in the pharmaceutical industry and its trade poor, elderly, and Degree of disparity in organizations to standardize and simplify those without health blood pressure control applications for patient assistance insurance coverage between general and programs that provide reduced-cost or priority populations free antihypertensive medications for low-income, underinsured, or uninsured individuals.
From page 195...
... antihypertensive medications continued 19
From page 196...
... In targeting hypertension Degree of reduction in the absence of such programs, the control Number of disparities in blood pressure DHDSP should work with state community health control between general partners to develop programs of worker programs population and populations community health workers who targeting hypertension served by community would be deployed in high-risk health workers communities to help support healthy living strategies that include a focus on hypertension. 6.7 SLHJs should promote and work with community health worker initiatives to ensure that prevention and control of hypertension is included in the array of services they provide and are appropriately linked to primary care services.
From page 197...
... 2008. Policy and system outcome indicators for state heart disease and stroke prevention, priority area: High blood pres sure control.


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