Building a healthier world

With increasing rates of childhood obesity and diabetes.

Dr. Raymond Gibbons, President of the American Heart Association, calls on healthcare professionals to work together in an effort to increase the health of all Americans – and the rest of the world’s populations.

The American Heart Association is a national voluntary health agency with a mission: to reduce disability and death from cardiovascular diseases and stroke. Sounds simple, but in the face of almost 80 million Americans with one or more forms of cardiovascular disease, it is not. Coronary heart disease causes half a million deaths each year, which makes it the single leading cause of death in America today.

What are the factors that lead to such daunting figures? With more than 440,000 Americans dying each year from tobacco-related disease, including more than 170,000 deaths from heart disease, stroke and other cardiovascular diseases, smoking is an undisputed cause. The FDA, most responsible for protecting the public health, has so far remained powerless to deal with the enormous risks of tobacco. Dr. Raymond Gibbons, President of the American Heart Association (AHA), is discontented: “The history of tobacco regulation is a disappointing one. At one point the FDA actually did tried to regulate tobacco. But their efforts were overturned in the courts, saying they didn’t have the statutory authority to do that. With the change in Congress this year we are hopeful that this may finally be the time when the FDA is given the authority to regulate tobacco.”

The Family Smoking Prevention and Tobacco Control Act, introduced on February 15, seems a step in the right direction, but Gibbons is cautious: “It has been introduced but it has not been passed. In the past, a similar bill was passed at one point by the Senate but not by the House. So we are just waiting to see what happens in Congress along with many others advocating for passage of this legislation.” If the FDA were to have statutory authority, it could regulate the amount of nicotine within tobacco and prevent advertising that implies that certain cigarettes are less harmful. “It’s those simple steps that we think will go a long way towards reducing the problem with tobacco related health disease,” says Gibbons.

Second-hand smoke

As a result of secondhand smoke, however, tens of thousands of nonsmokers also die in the US each year from coronary heart disease. This, Gibbons believes, is a matter of increasing public importance. A growing number of states have passed clean air legislation that regulate where people can smoke. This has reduced the exposure of many Americans to second-hand smoke. “There are currently 18 states and many cities that have passed such legislation. The number has grown rapidly over the last few years. Many additional states have such legislation under consideration. At this point, the best estimate is that more than 50 percent of Americans have minimal exposure of second-hand smoke by virtual effect that they live in stated or cities where the public use of tobacco is not allowed,” remarks Gibbons.

While first and second hand smoke kill hundreds of thousands of Americans, childhood obesity has become of even more concern for public health. Its future manifestations for cardiovascular health in the country, Gibbons predicts, are going to be enormous: “The generation of current students graduating from secondary school in the US may well be the first generation who will not outlive their parents because so many of them are already overweight and obese. This tends to track into adulthood, so adolescence who are overweight at the end of secondary school are much more likely to end up as overweight and obese adults,” explains an alarmed Gibbons.

With efforts such as “The Alliance for a Healthier Generation”, the AHA is campaigning in collaboration with the William J. Clinton Foundation to raise awareness. “We bring in the science, and President Clinton brings the ability to gain attention and access to the necessary leaders in industry who can help. The alliance has only been underway for about three years but it has already had a major impact,” Gibbons says. A considerable achievement was last year’s agreement with soft drink manufacturers in the US not to supply high calorie soft drinks to vending machines in schools. Snack food manufacturers supplying their products to schools also agreed that they will follow dietary guidelines, which the AHA has developed to restrict the amount of calories and sugar.

Childhood obesity

With a broad schools’ initiative, which currently involves over 1000 schools in the US, the AHA is aiming to collect information intended to enable healthcare professionals to offer better advice to parents and adolescence. Gibbons: “We want them to encourage increased activity in children and adolescence. These days, our society is dominated by computer games and the Internet. That’s a lot of time sitting at the computer terminal that children and adolescence used to spend in activity. Healthcare professionals can play a big role in encouraging more physical activity, better lifestyle habits, and eating the right foods.” Components of the schools’ program were modelled after a state effort in Arkansas, where Governor Mike Huckabee has became an advocate of broader public health initiatives to combat childhood obesity. Latest data from Arkansas shows that it is the only state in the US where the rate of childhood obesity is no longer increasing, proving that within a few years, a major problem such as childhood obesity can be modified.

It’s not all about children, however. Physical inactivity is a generation-wide concern. People of all ages spend more hours at work in sedentary jobs and less time exercising, which is contributing to the growing problem of obesity and diabetes in the US. “Start!”, which is the AHA’s initiative to increase exercise particularly in the workplace, calls on all Americans and their employers to create a culture of physical activity and health to live longer, heart-healthy lives through walking.

Another initiative the AHA has designed is called “Go Red for Women”, which began in February 2004. The movement gives women tips and information on healthy eating, exercise and risk factor reduction, such as smoking cessation, weight maintenance, blood pressure control, and blood cholesterol management. “In the US,” says Gibbons, “we have been rather successful in decreasing age-adjusted cardiovascular mortality over the last 20 years in men but we have made far less progress in women. In large parts, that is because women have not paid enough attention to their own cardiovascular health. They have been more concerned about others in their family than they have been about taking car of themselves. They have also been much more worried about things like breast cancer than they have about cardiovascular disease, even though they are eight to 10 times more likely to die of cardiovascular disease than breast cancer.”

Healthcare disparities

In an effort to reduce healthcare disparities and promote healthy lifestyles in minority communities, “The Power to End Stroke” is the AHA’s attempt to heighten the awareness and impact of stroke in the African American community. The movement, started by the American Stroke Association, includes tools to help African Americans understand and reduce risk, learn the warning signs of stroke, and recognize that stroke is a medical emergency.

Gibbons is committed to the importance of diversity and addressing healthcare disparities in the country. In any of the campaigns the AHA monitors, the organization specifically makes an effort to sample minority populations to ensure it reaches all groups. Gibbons: “We have national data with separate tables of data regarding minority populations. Part of that effort is to recognize the importance of having more materials available in Spanish. The board of the AHA authorized significant expenditures to increase the amount of materials available on our website in Spanish, particularly the materials that are available as part of “Go Red for Women” to do a better job at reaching Hispanic women.”

An advertising challenge

Gibbons believes that one of the greatest challenges the US has yet to come to terms with is advertising: “The media are bombarding our citizens on a regular basis. The amount of money we spend on paid advertising is trivial compared to what is spent in advertising food products or soft drinks. One of our challenges is not to be lost in the noise of all of those other messages that are present in the advertising world. The second challenge is to get people to stop and think about their personal health, their lifestyles, so that they take the time to exercise, eat right, and modify their lifestyles.”

In the future, Gibbons wants to concentrate on the prevention of costly disease. At a time of concern about rising healthcare cost in the US and other Western industrialized nations, this seems an effective approach to improve health and reduce some of those costs. “Diabetes and obesity are worldwide problems. Multiple countries are facing rapid increases in healthcare cost. If we look ahead, there is no question that the problem that will be of greatest magnitude is the increasing rate of diabetes in China. We need to share information and approaches to improve the health of our populations so that we can all try to work together to build a healthier world free of cardiovascular disease and stroke,” says Gibbons, leaving his vision to inspire healthcare professionals across the world.

Dr. Raymond Gibbons (speaking): “An Arthur and Gladys D. Gray Professor of Medicine at the Mayo Clinic in Rochester, Minnesota, Dr. Raymond Gibbons has an active research program primarily in heart attacks and measurement of heart attacks. While on Mayo’s staff for the last 25 years, he has also held a variety of positions within the American Heart Association, culminating in becoming the organization’s President for this year.”

“From left to right: Dr. Barry Franklin (AHA volunteer and Start! spokesperson), Dr. Gibbons, Jane Seymour (AHA/Start! celebrity spokesperson), Andy Buroker (AHA Chairman of the Board), Cass Wheeler (AHA CEO).”

“President Clinton surrounded by students from A. Philip Randolph Campus High School in New York following the announcement of deal brokered with five leading food companies to bring healthier products to the nation’s schools.”
Credit: John Wilson/Alliance for a Healthier Generation

“President Bill Clinton announcing the collaboration between the Alliance for a Healthier Generation and five of the nation’s leading food manufacturers to establish the first-ever voluntary guidelines for snacks and side items sold in schools that will provide healthier food choices for the nation’s children.”
Credit: Todd France/Clinton Foundation

Dr. Raymond Gibbons: “The generation of current students graduating from secondary school in the US may well be the first generation who will not outlive their parents.”