Can policy reverse the heart disease epidemic?

Heart disease is the number one killer of Americans. And while most people know the basics of how to keep their heart healthy – exercise regularly, don’t smoke, eat healthy, have an annual physical – most people simply can’t.

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Can policy changes like banning trans fats solve the heart disease epidemic?

To be sure, this isn’t a blame game. Many people live in food deserts and don’t have access to healthy choices. Yet, their neighborhoods are filled with fast food restaurants and small grocery stores selling high-calorie, high cholesterol food at the cheap. American workers put in more hours than any other first-world country. The pressure and competition of the job market makes it hard to balance a healthy lifestyle. And up until recently, more than 30 million Americans were without health insurance and unable to access a doctor – never mind a cardiologist – without incurring heavy out-of-pocket costs.

“Regarding heart disease, there are major disparities between minority and non-minority communities in a number of risk factors, including diabetes, hypertension and obesity,” says Dr. Garth Graham, president of the Aetna Foundation. “To compound this issue there are also disparities in access to care and how quickly at-risk individuals are referred to a specialist for coronary angiography and other important tests.”

So how do we turn heart disease rates around for everyone in this country? The answer may be policy.

Dr. Graham says the Affordable Care Act has tremendous potential when it comes to reducing the disparities seen in the treatment of heart disease for minorities and other underserved populations.

“By extending access to care, we could potentially see earlier detection and treatment of disease.”

Twenty-eight states have banned smoking in at least some public places, like restaurants and bars.

Several cities and counties took the lead on banning trans fats in their eateries. Now the federal government is following suit, although no timeline for banning trans-fats on a national level has been announced.

While some states have been listing calorie counts on menus for several years, the ACA mandates all chain restaurants with 20+ locations to disclose nutritional information on standard menu items.

Addressing the problems of food deserts, Dr. Graham points to Green Carts, a New York City program implemented in 2008 that introduced kiosks full of fresh fruits and vegetables throughout the city, increasing access to healthy foods for residents who previously had little to no access.

“While there are a number of programs throughout the country supported by both government agencies and non-profit organizations, there is always more than can be done,” he says.

Beyond policy, Dr. Graham believes technology will be a great equalizer for improving health education and access to care.

“Solutions range from sharing emails with your physician between visits to using a fitness app that tracks your workouts,” he says. “Talk to your physician about the types of technology and applications they recommend using to help you improve your overall heart health.”


Garth Graham, MD, MPH, is president of the Aetna Foundation. In his role, Dr. Graham is responsible for the Foundation’s philanthropic work, including its grant-making strategies to improve the health of people from underserved communities and increase their access to high-quality health care. A national authority on health disparities and health care quality, Dr. Graham is a frequent spokesperson for the Foundation on health care and health equity issues. Dr. Graham previously served as deputy assistant secretary in the U.S. Department of Health and Human Services, where he also led the Office of Minority Health.