Population Health and Primary Prevention in the Spotlight

MartinThis post was authored by Gerard R. Martin, MD, FACC, chair of the ACC’s Population Health Policy and Health Promotion Committee.

We’re currently at a crossroads of health care delivery and health promotion. Up until now, we, as cardiovascular professionals, have been laser focused on secondary prevention, only scraping the surface of primary prevention. While technological and educational advances over the last few decades have resulted in a significant reduction of cardiovascular disease (CVD) in the U.S., the burden of CVD is set to increase 57 percent by 2020 worldwide.

To adjust to this new landscape, we must shift the paradigm from treatment to prevention and begin moving towards population health if we want to kick CVD off the list as the world’s #1 killer. This is no easy task. Population health – which is at a complex intersection between an increasingly diverse population, an evolving health care system, traditional public health and elaborate social policies – is not easy to define. I can guarantee that each and every one of us has a different perspective on the topic, making it difficult to come to a consensus on how best to move forward.

ACC is a longtime leader in efforts to reduce the burden of cardiovascular disease in U.S. and global populations. As part of its Strategic Plan, the College is revving up efforts to engage partners and pursue global cardiovascular-related objectives, support members to improve the health of populations, and encourage cardiovascular team-facilitated patient education. In order to help guide the College as it pursues population health opportunities, the ACC recently formed a Population Health Policy and Health Promotion Committee, of which I’m honored to be the chair.

This week, the ACC took a monumental step towards moving into this space when it hosted a retreat to help shape the College’s population health policy agenda. Specifically, the retreat aimed to define population health and health promotion for the ACC, discuss whether the College is prepared to engage in primary prevention, and prioritize partners and targeted activities related to population health and health promotion in the College.

The meeting convened ACC members and a diverse array of experts from government agencies, universities, medical specialty societies and private sector partners to discuss primary prevention, health equity and social determinants of health, the changing health care landscape, and the role of primary care professionals in advancing cardiovascular health. The impressive lineup of speakers, which included experts from the Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services, CVS Health, Harvard Medical School, Pan-American Health Organization, U.S. Department of Agriculture, U.S. Food and Drug Administration, U.S. Department of Health and Human Services (HHS), Walmart, the White House and more, shared how their organizations are making strides in reducing heart disease. The presenters energized the room full of ACC members and representatives of our partner organizations who are ready to hit the ground running to impact population health.

David Nash, MD, MBA, dean of the Jefferson School of Population Health, the only school of its kind, kicked-off the conference with a “big picture” view of the current population health landscape. Nash pointed out that the U.S. spends under 2 percent of its health dollars on population heath, and chronic diseases, which comprise 80 percent of total disease burden, have no dedicated federal funding stream.

Furthermore, smoking, unhealthy diet, physical inactivity and alcohol use account for 40 percent of all deaths.  According to William Dietz, MD, PhD, director of the Sumner M. Redstone Global Center at George Washington University, no one change will make an impact in patients. Instead we need multiple interventions at multiple levels and proven strategies for schools, workplaces and communities.

Debra Eschmeyer, senior policy advisor for nutrition at the White House and executive director of Let’s Move! , shared how First Lady Michelle Obama’s campaign is making an impact on children’s health. Let’s Move! is focused on creating a healthy start for children, empowering parents and caregivers, providing healthy food in schools, improving access to healthy, affordable foods, and increasing physical activity. Eschmeyer stressed that they can’t do it alone and “physicians and health care providers have a key role to play in primary prevention ensuring that kids and families grow up healthy.” Karen DeSalvo, MD, MPH, MSc, acting assistant secretary for health at HHS, echoed Eschmeyer’s points, stressing the importance of building healthy environments where people live, learn, work and play.

It’s not just government agencies that are impacting population health. Private sector companies are increasingly making bold moves to improve the health of their customers. During the retreat, William Shrank, MD, chief scientific officer for CVS Health, shared how a study showing that high risk patients were purchasing tobacco products at retail pharmacies prompted the pharmacy chain to stop selling cigarettes. Daniel Stein, MD, MBA, director of medical and clinical services at Walmart, outlined the company’s plans to roll out Walmart Care Clinics to fill an important gap in the primary care landscape. With an estimated 65 million people living in areas with a primary care shortage and Walmart serving 140 million Americans in more than 6,000 stores each week, these clinics could have a dramatic impact on millions of underserved patients.

Other medical associations, including the American Medical Association, American Academy of Pediatrics and American Heart Association, also provided a glimpse into their efforts in primary and secondary prevention.

Following its engagement with partners at the retreat and subsequent internal deliberation, the Committee will be working with its partners inside the ACC as well externally to build a population health agenda for the College that encompasses a holistic view of health promotion. The agenda, which will include elements of primary and secondary prevention and specific goals and targets related to diet, nutrition and exercise, will be presented later this year to the Board of Trustees. In keeping with the holistic theme, the College will continue to support efforts in related areas, such as tobacco control and prevention. The agenda will encompass work in the state, national and international arenas.

While we have only just begun to dip our toes into the population health waters, there is tremendous enthusiasm by members and partners and numerous opportunities on the horizon for the College. The Committee will be hard at work setting a framework for the ACC’s health promotion efforts and I look forward to sharing our progress with you in the coming months.

5 thoughts on “Population Health and Primary Prevention in the Spotlight

    • Dear Dr. Solomon,
      Glad you enjoyed the summary! While we weren’t able to have the Surgeon General attend, we look forward to reaching out to him in the near future regarding ACC’s population health efforts.

  1. Dear Dr. Martin, I am a recently retired cardiologist, still working for our local health system, Peace Health. I am currently Research Medical Director for the organization’s Center for Medical Education & Research. Peace Health is pursuing population health as a high priority and long term goal. I would be interested in some detail and summaries of your recent ACC retreat dealing with what the ACC’s approach to population health should be. I appreciate any more detailed information you may send.
    Respectufully, Jerold A. Hawn, MD.,FACC

    • Dear Dr. Hawn,
      Thank you for your comment! The ACC’s Population Health Policy and Health Promotion Committee is just kicking into gear. We will be hard at work shaping the College’s population health and health promotion agenda in the coming months, so stay tuned to the Blog for details and insights about our progress.

  2. Prevention in the Age of Complexity:

    Congratulations on this much needed and timely initiative. I would like to mention two relevant initiatives that may be of interest, presented as posters at the 13th International Symposium on CVD Prevention in Miami, 2015.

    1) CVD Prevention for the 21st Century: a 25 year experience with a systems and complexity approach.
    2) Beyond CVD Prevention: Creating a pandemic of health using complexity, the science for the 21st century.

    The 21st century is considered the Age of Complexity, with complex dynamic nonlinear network-like interactions leading to health and disease, requiring a systems and complexity approach for change. Complexity, the science for this for the 21st century according to Stephen Hawking, can be the science for this.

    The Dalla Lana School of Public Health, University of Toronto, has taken health promotion further, proposing Creating a Pandemic of Health, at a Global Summit in 2014, with our poster proposing complexity as its science – http://pandemicofhealth.ca/wp-content/uploads/2014/10/1-09-Rambihar-Complexity-the-Science-of-Health-and-for-Creating-a-Pandemic-of-Health-Stream.pdf

    The Institute of Medicine and many other agencies are now including systems and complexity thinking in health and health promotion.

    We would like to share our 25 year experience with complexity and CVD health promotion, and invite the ACC to consider a systems and complexity approach for its Population Health and Primary Prevention initiative, and in creating health.

    Readers can find more on this experience at the Royal College of Physicians and Surgeons of Canada International Clinical Educators Network blog (ICEnet) –

    http://icenetblog.royalcollege.ca/2014/06/17/emerging-concepts-in-medical-education-v-complexity/
    including reference to a book chapter available online, “Using Complexity Science in Community Health Promotion: novel perspectives and a tool for change.”

    Vivian S Rambihar MD, FRCPC, FACC.

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