Table 2-8.

AHA Advocacy and Policy Strategies Related to the 2020 Impact Goals for Ideal Cardiovascular Health

Measure of Cardiovascular Health	Advocacy/Policy Solutions
Smoking Status  Ideal for cardiovascular health:  Adults: Never smoked or quit more than a year ago  Children: Never tried or never smoked a whole cigarette	Federal Support the full, authorized funding level for the FDA’s Center for Tobacco Products and advocate for comprehensive implementation of FDA regulation of tobacco. Implement clinical guidance and monitor health claims concerning smokeless tobacco and other “harm reduction” products. Support the Tobacco Tax Equity Act that closes tax loopholes to ensure that all tobacco products are taxed at levels similar to the current tax rate for cigarettes. Continue to advocate for ratification of WHO’s Framework Convention of Tobacco Control as part of the UN Political Declaration on Non-Communicable Diseases for implementation by all countries who are a party to the treaty.
	State Establish, strengthen, and protect smoke-free air laws in compliance with the Fundamentals of Smokefree Workplace Laws guidelines. Support tobacco-free secondary school, college, university, and hospital campuses. Support significant increases in tobacco excise taxes on all tobacco products. Establish and protect sustainable funding for tobacco prevention and cessation programs to levels that meet or exceed the CDC recommendations. Provide comprehensive tobacco cessation benefits in Medicaid, Medicare, and private health insurance plans. Eliminate tobacco sales in pharmacies and other health-related institutions.
Physical Activity  Ideal for cardiovascular health:  Adults: At least 150 min of moderate or 75 min of vigorous PA each week  Children: >60 min of moderate-vigorous PA per day	Federal Preserve funding for Safe Routes to School and Complete Streets in Transportation Reauthorization. Include PA in nutrition education funding for the Farm Bill Supplemental Nutrition Assistance Program. Incorporate PA into electronic medical records. Support implementation of the National Physical Activity Plan. Increase the quality of physical education in schools and advocate for Physical Education for Progress grants to increase funding to schools to improve their PE programs. Advocate for regular revision and update of the Physical Activity Guidelines for Americans.
	State Implement shared use of school facilities within the community and support the construction of school fitness facilities. Increase sports, recreational opportunities, parks, and green spaces in the community. Support efforts to design workplaces, communities, and schools around active living and integrate PA opportunities throughout the day. Provide safe routes to schools and school sites that offer walking/biking options for more students. Support the creation of complete streets. Support the use of zoning policy to increase access to safe places for recreation. Create and maintain comprehensive worksite wellness programs. Support the creation and implementation, through legislation and regulation (including licensing), of PA standards for preschool, day care, and other out-of-school care programs. Require quality, more frequent physical education in schools. Promote efforts within the school environment that will lead to increased PA.
BMI  Ideal for cardiovascular health:  Adults: between 18.5 and 25 kg/m2  Children: between the 15th and 85th percentile  Go to www.americanheart.org/obesitypolicy for additional policy resources	Federal Provide obesity counseling and treatment coverage in the healthcare environment. Provide robust surveillance and monitoring of obesity, diet, PA, and tobacco use.
	State Provide robust coverage for guidelines-based prevention, diagnosis, and treatment of overweight and obesity in the healthcare environment. Implement and monitor strong local wellness policies in all schools. Ensure adequate funding and implementation of coordinated school health programs. Establish comprehensive obesity prevention strategies in early childhood and day care programs. Advocate for continued funding for obesity prevention research and work to ensure a strong evaluation component is a part of implementation of new laws and programs.
Healthy Diet  Ideal for cardiovascular health:  In the context of a DASH-type dietary pattern, adults and children should achieve at least 4 of the 5 following key components of a healthy diet: Fruits and vegetables: >4.5 cups/d Fish: More than two 3.5-oz servings/wk (preferably oily fish) Fiber-rich whole grains (>1.1 g of fiber per 10 g of carbohydrates): three 1-oz-equivalent servings per day	Federal Work to eliminate food deserts and improve access and affordability of healthy foods. Strengthen nutrition standards in schools for meals and competitive foods and in all government nutrition assistance or feeding programs. Improve food labeling to make the labels easier to read and convey more accurately the content of added sugars, trans fats, sodium, and whole grains in foods. Implement menu labeling in restaurants. Continue to support and monitor the removal of industrially produced trans fats from the food supply and ensure the use of healthy replacement oils. Restrict the marketing and advertising of unhealthy food to children. Support robust implementation of nutrition education and promotion in schools. Reduce added sugar and sodium in the food supply. Support the implementation and dissemination of procurement standards across federal agencies. Ensure that diet counseling is a covered benefit in Medicare.
Sodium: <1500 mg/d Sugar-sweetened beverages: <450 kcal (36 oz) per week Go to www.americanheart.org/obesitypolicy for more specific policy resources	State Support the implementation of the reauthorization of the Federal Childhood Nutrition Act and new regulations concerning competitive foods and beverages and use all available techniques, including legislation, to encourage schools to take advantage of opportunities to provide even healthier options for children. Support improvements in the school food environment just outside of school property, including corner stores and food trucks Support the creation and implementation of nutrition standards, through legislation and regulation (including licensing), for preschool and day care and other out-of-school care program meals. Support opportunities for greater nutrition education in schools. Support opportunities to expand the availability of fruits, vegetables, and water, including policies that support expansion of school gardens and farm-to-school programs. Support strategies that reduce sodium in the food supply. Reduce trans fats in packaged foods, baked goods, restaurant meals, and school meal programs. Support the elimination of food deserts through policies such as Healthy Food Financing that increase the availability of fruits, vegetables, and water in underserved neighborhoods. Support the establishment of food procurement policies that meet the AHA or federal guidelines for government offices. Support policies identified to reduce children’s exposure to marketing and advertising for unhealthy food. Support policies that change relative prices of healthy versus unhealthy food items. Support on a pilot basis the taxation of sugar-sweetened beverages to assess impact on health and consumer behavior, including 6 minimum criteria (at least a portion of the money is dedicated for HD and stroke prevention and/or obesity prevention, the tax is structured so as to result in an increase in price for sugar-sweetened beverages, tax is at least 1 cent/oz, there is money dedicated for evaluation with guidance that ensures rigorous evaluation including health outcomes, there is a standard definition of “sugar-sweetened beverage,” and there is no sunset). Support policies designed to encourage retailers to increase access to healthy foods while decreasing access to unhealthy foods. Expand state participation in the Department of Defense Fresh Fruit and Vegetable program.
Total Cholesterol  Ideal for cardiovascular health:  Adults: Total cholesterol <200 mg/dL  Children: <170 mg/dL	Federal and State Partner with Department of Health and Human Services to promote the Million Hearts Campaign through increased public awareness and partnership engagement, science and evaluation, clinical care improvement, patient outreach, and public policy. Ensure adequate healthcare coverage for prevention and treatment of dyslipidemia. Secure and protect dedicated state appropriations aligned with HD and stroke priorities and work to support appropriate program implementation. Support other public health initiatives and evaluation targeted at HD, stroke, and related risk factors, as well as the disparities that exist in these areas.
Blood Pressure  Ideal for cardiovascular health:  Adults: <120/80 mm Hg  Children: <90th percentile	Federal Partner with the Department of Health and Human Services to promote the Million Hearts Campaign, as above. Implement the Institute of Medicine’s recommendations to reduce sodium in the food supply. Improve food labeling to increase consumer understanding of sodium levels in packaged foods. Advocate for robust sodium limits in procurement standards, nutrition standards in schools, and other government feeding programs.
	State Promote public funding for Heart Disease and Stroke Prevention Programs. Ensure the availability of essential CVD preventive benefits in private insurance and public health programs.
Fasting Plasma Glucose  Ideal for cardiovascular health:  Children and Adults: Fasting blood glucose <100 mg/dL	Federal and State Ensure adequate healthcare coverage for early treatment and prevention of diabetes mellitus.

For AHA advocacy resources, including fact sheets, policy briefs, published papers, and position statements, go to http://www.heart.org/HEARTORG/Advocate/PolicyResources/Policy-Resources_UCM_001135_SubHomePage.jsp.

AHA indicates American Heart Association; FDA, Food and Drug Administration; WHO, World Health Organization; UN, United Nations; CDC, Centers for Disease Control and Prevention; PA, physical activity; PE, physical education; DASH, Dietary Approaches to Stop Hypertension; HD, heart disease; and CVD, cardiovascular disease.