Better population health through behavior change in adults: a call to action.

Abstract

The American Heart Association (AHA) has adopted a bold new strategy in framing its 2020 goals: “By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%.”1 By medically treating cardiovascular risk biomarkers and the disease itself, clinicians played a major role in achieving the AHA’s 2010 goal to reduce coronary heart disease, stroke, and risk by 25%.1 Now, however, with direct annual cardiovascular disease–related costs projected to triple, from $272 billion in 2010 to $818 billion in 2030,2 economic realities necessitate a new approach. To avoid bankrupting the healthcare system, we must improve the distribution of cardiovascular health levels across the population by preserving cardiovascular health from childhood and by treating health risk behaviors to help more individuals improve their cardiovascular health into older ages. This heightened emphasis on preventing disease by addressing health behaviors leads to 3 novel emphases in the 2020 goals: (1) Preserving positive “cardiovascular health” by promoting healthy lifestyle behaviors; (2) treating unhealthful behaviors (poor-quality diet, excess energy intake, physical inactivity, smoking), in addition to risk biomarkers (adverse blood lipids, high blood pressure, hyperglycemia, obesity); and (3) a combination of individual-level and population-based health promotion strategies that aim to shift the majority of the public toward the next level of improved cardiovascular health. The 7 metrics that define cardiovascular health (smoking, diet quality, physical activity level, body mass index, blood pressure, blood cholesterol, and fasting blood glucose) are each classified into 3 clinical strata (ideal, intermediate, and poor). Individuals with all 7 metrics at ideal levels are considered to have “ideal cardiovascular health.” However, the prevalence of ideal cardiovascular health is very low in the US population, and the prevalence of poor-quality diet, physical inactivity, and overweight/obesity is alarmingly high, presaging …