Leading from the Front

By Natalie Brandweiner, Deputy Editor

Nancy Brown tells EHM about her sense of responsibility and excitement following her recent appointment as CEO of the American Heart Association.

“We've got to get people to change their lifestyles before they develop risk factors for serious disease”
-Nancy Brown, The American Heart Association

As the first female to take office as CEO of the American Heart Association, Nancy Brown has found her recent transition from COO surprisingly smooth, given the current state of the economy and the excitement surrounding the election of the new administration in Washington. Her role as Chief Executive took effect on January 1, and for Brown, there couldn’t be a more thrilling time to take office: “We’re very excited about the new administration’s focus on health and healthcare, and issues that are important to the AHA.”

Brown held the position of COO for seven years, and so is well equipped to lead the association; being the first female to find herself in such as position has not posed any challenges, she tells me. “One of the things I have treasured in my career is that the association has always given me and other women the opportunity to advance and succeed. I’m certainly very proud to be selected as the first woman to lead the AHA.”

As COO, Brown had an established relationship with Cass Wheeler, AHA’s previous CEO, and was influential in bringing about many of the changes he implemented. Wheeler ran the association along the lines of a private business, resulting in the streamlining of its operations and an increase in funds. As an integral part of Wheeler’s team, Brown was a part of this strategy and is sure to continue running the organization on such profitable lines,” she says. “I’m committed to running the AHA like a business and have a very corporate mentality.”

Maintaining a presence in shaping the direction and the strategic plan for the organization, Brown has had a hand in forming the association’s major decisions from the shadows long before her appointment as CEO. Many of its cause initiatives in the past, such as ‘Go Red for Women’ and the ‘Alliance for a Healthier Generation’, can be attributed to her.

2020 impact goal
“We are about to announce our new 2020 strategic impact goal, which will guide the work of the organization for the next decade,” Brown says. “There may be the need to focus resources on newer, higher priority initiatives or activities that come out of that new strategic plan.

“We are committed to being nimble as an organization, allowing our resources to move and support the priorities that we have. In terms of the changes that I’ll make as CEO, one of the things I’ll be doing over the coming weeks and months is connecting with our staff and volunteers from across the AHA to hear their ideas about the future of the organization. I’m very confident about the future of the AHA because we’ve got such terrific volunteer leaders and a great staff team, along with an important mission and strategic goals. It’s extremely important for me to listen to the ideas others have about the organization as I finalize plans for any near-term changes that I might make.”

Brown’s main focus as CEO is to work very closely alongside the new administration, bringing greater representation to American heart patients, along with highlighting the broader issue of the ever increasing amount numbers of uninsured. Brown aims to do this through the implementation of the 2020 impact goal.

“Our 2020 impact goal seeks to reduce coronary heart disease and stroke risk by 25 percent by the year 2010. We have achieved already the mortality reductions for coronary heart disease and stroke, and we’re making progress on some of the risk factors, but not all of them. This goal will continue to focus on reducing death rates from coronary heart disease and stroke, but a very exciting new component is a focus on improving the cardiovascular health of Americans.

“There does not currently exist a metric for measuring the status of cardiovascular health, and so the volunteer leaders of the AHA, through our science community and our epidemiology council, have created one. We will release a stated goal for the next decade that will hold the organization accountable to having a measurable improvement in the cardiovascular health of Americans by a certain percent.

“This will shift the organization’s thinking very much to prevention. It will also have us focusing on moving people who are at poor health to intermediate health, and people who are at intermediate health to optimal health,” explains Brown.

Preventative care
The shift in focus to preventative healthcare has spread across the industry – even finding its way into President Obama’s inaugural speech – and Brown and the AHA are no exception. In September 2008, the AHA released a set of guiding principles for initiating change in the US healthcare system, setting out preventative benefits as an essential component of a healthcare infrastructure.

“For us as an organization, and externally when we think about healthcare and healthcare reform, we’ve got to get people to change their lifestyles before they develop risk factors for serious disease. Just look, for example, at the increase in the numbers of people suffering from obesity and type 2 diabetes. We’re really concerned about that, as are many other organizations and people who care about the status of health.

“If you look at the population as a whole, there are many people who have risk factors for cardiovascular disease – high blood pressure, high cholesterol, they’re obese, they have type 2 diabetes, they’re not exercising – and so the important mix for the AHA will be to continue with our robust disease management offerings to the public to help them manage their risk. The overall trend for healthcare has to be to focus on the obesity and diabetes rates, but not forgetting about those people who already have significant risk that need to have that risk managed,” says Brown.

New plans
In a previous issue of this magazine, Wheeler give a scathing account of the current system and its hopelessness: “It’s a system not about health, but about sickness; it’s not about care, it’s about money; and it certainly is not about a system, because a system implies that all parts work together.”

Brown also believes our healthcare system is broken: “The whole system focuses on treating people after they have been diagnosed with a disease not helping them to prevent it,” she says. Obama’s administration has focused heavily on highlighting prevention as a strategy to underline his new policies, and Brown is fully supportive of Obama as a leader. She notes the rising number of those unable to visit their doctor or fill their prescriptions, due to the economic crisis, and believes this will have a long-term averse affect on the American healthcare system. “We’ve got to have a new model. We’ve got to focus on prevention and find a way to make our healthcare system economically viable. President Obama and his team will make that a major priority, both because it’s the right thing to do and because it’s an economic issue for the country.”

Providing quality healthcare to uninsured Americans has always been the AHA’s primary aim, Obama or not. However, the new administration’s commitment to preventative services certainly makes it easy for the AHA to work alongside them. “We encourage President Obama and all the decision-makers to support legislation that will help prevent chronic disease, eliminate disparities and expand preventive care, as well as supporting research, medical education and clinical training. For example, we hope the covered services will include things that we know are important to preventing cardiovascular disease, like blood pressure, cholesterol, and blood sugar monitoring and smoking cessation.

“The fact that this is high on President Obama's radar screen is a really important thing, both for healthcare and for the economy of the US as a whole, because the medical system in this country is currently a drain on the financial wellbeing of the US, and there are ways that that can be turned around,” says Brown.

The correlation between rising figures of unemployment and the uninsured is of great concern to Brown. As she explains, “Corporations are having to face tough decisions about how to trim their budgets, so some might find themselves increasing co-pays and deductibles for office visits and prescription drug refills, and some individuals may not feel that that’s something they can afford if they have to make a choice between feeding their family or getting their prescriptions refilled. So these are things that have got to get under control for the stability of the healthcare system in the United States.”

Obama has set as his target providing coverage to 46 million uninsured people, and despite much skepticism from within the industry as to the feasibility of reaching this figure, Brown is in full support. “Covering the uninsured has to be a priority, because it fits in with the overall reform of the healthcare system, which ultimately will make the country more financially viable,” she says.

“We’re optimistic that the goal of providing quality, affordable healthcare to the uninsured can be achieved through measures that support a sustained investment in medical research, coverage for existing conditions, health information technologies that will help providers make guideline-based treatment decisions, as well as the state-based heart disease and stroke prevention programs and other prevention and wellness programs that are in the package.”

Leadership
Brown’s debut has come at both a challenging and exciting time. The intrinsic link between the economy and healthcare means she must set the bar high in terms of leadership, and ensure the AHA continues in its success, both as a representative for patients and as a structured organization. “I want to continue the fine tradition of leadership that Cass has displayed in the organization over the past decade. In terms of the mission of the organization, I’ll be making sure that we are well prepared to focus our resources on achieving the 2020 strategic impact goal, and that will require new expertise in the organization, volunteers and staff.

“As we look at the external trend that all of us will need to deal with – the economic situation, the global opportunity for the association to have more of a global impact, the changing in the demographics and aging of the population – all of those things will require the AHA to look and act differently moving forward. If you look at just the onset of social media and how we focus on communicating our messages to the public, that will have a dramatic shift in the short and long term. These are all things that we’ll be doing to prepare the organization for the 2020 goal.

“Certainly our work and systems have changed, and healthcare reform will remain a major priority for me, as will the research enterprise of the association, and our advocacy function as well. The other thing that we’ll be very focused on is communication and messaging, and how to get the attention of Americans about the fact that they are creating this lifelong risk for themselves by not caring for themselves when it comes to obesity, type 2 diabetes and managing their weight,” says Brown.

Educating the American public about the dangers of such diseases has always been at the forefront at the AHA, regardless of leadership. The organization has been extremely resourceful in finding different media through which to project its message, recognizing that over time the way in which they reach the public has changed. Brown explains that during the 1990s, traditional public service announcements were used to educate the public, which changed to paid advertising in the mid 2000s.

“We are looking at continuing with those more traditional forms of outreach to the public, as well as our ad council campaign, but also adding a lot more social media, trying to engage people that way to care about their risk for heart disease. We have our cause campaigns, ‘Go Red for Women’, ‘Power to End Stroke’, the ‘Alliance for a Healthier Generation’ and our physical activity campaign ‘Start’, which all also engage people in caring about themselves and others, and then of course we have media strategies, celebrity strategies and other forms of media outreach.”

“We’ve also just developed and launched our new global strategic plan. We have a lot of work to do here in the US, but heart disease and stroke are global burdens, and we believe the American Heart Association can play a major role in helping with the global burden of cardiovascular disease. So we’ll be extending the reach of the association even more broadly in the global marketplace than it is today.”

The AHA’s diligent campaign on behalf of the uninsured looks like it’s about to pay off with the arrival of the new administration. The staff in the DC office is engaged with Obama’s team, providing ideas for health IT and funding for medical research. With so much in its favor, now is the time for the AHA to work even harder to reach its goals.

Since 1986, Nancy Brown has worked with the American Heart Association in a variety of roles, including as Metro Detroit Director in the Michigan Affiliate and as the AHA’s Chief Operating Officer. Prior to joining the AHA, Brown served as Director of Development/ Deputy Director of the Endowment Campaign for the Michigan Cancer Foundation, and as Special Events Director for Mount Carmel Mercy Hospital in Detroit.