Advocacy Pulse - heart.orgwcm/@adv/documents/downloadable/... · Advocacy Pulse Above photo: Washington advocates and staff at the capitol in Olympia, lobbying for CPR in schools

1 www.yourethecure.org

I am pleased to again this year present you with our annual report of state and local public policy progress. We take pride in the diligent efforts of our advocates, volunteers and staff who ensure that we remain focused on helping improve the cardiovascular health of all Americans. As you

read this report you will quickly realize that we saw unprecedented public policy success across the country during this last fiscal year. The victories you will read about in the following pages have a direct and profound impact on our 2020 national goal: To improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent.

As we review our 2012–2013 state and local public policy, we should be proud of our active advocacy presence in all 50 states, the District of Columbia, and Puerto Rico. We provided staff support and policy resources to local elected officials and state legislators as they drafted and passed legislation and enacted regulations related to cardiovascular disease and stroke. Our state advocacy staff teams provided media advocacy, grassroots advocacy, and direct lobbying support.

We helped support the passage of state laws and local ordinances that impact heart disease and stroke risk factors as well as policies that further protect survivors of heart disease or stroke.

2 0 1 3 L E G I S L AT I V E W R A P - U P July 2012 – June 2013

Advocacy Pulse

Above photo: Washington advocates and staff at the capitol in Olympia, lobbying for CPR in schools.

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State Success StoriesDuring the 2012–2013 fiscal year we saw legislation passed at the state level that will move us closer to our 2020 goal by assuring all newborns are screened for critical congenital heart disease, improving stroke care, assuring students are trained in lifesaving CPR before graduating high school, reducing obesity and encouraging physical activity, increasing public funding for heart disease and stroke, and preventing tobacco use.

Our significant public policy achievements include public policies enacted in fifteen states that will assure all newborns are screened for critical congenital heart disease before going home for the first time. Seven states enacted new laws that will assure all students have been CPR trained before they graduate from high school. In the area of encouraging physical activity, two states passed shared use laws that will expand opportunities for physical activity in communities across those states. Six states enacted policy that will strengthen their stroke systems of care and six states moved to strengthen their STEMI systems of care. Four states were successful in increasing their public funding for heart disease and stroke at the state level. Tobacco tax increases occurred in three states and two states moved to strengthen their smokefree air laws.

On behalf of the thousands of You’re the Cure advocates, association volunteers, donors, and staff who have made these successes possible, it is my pleasure to present to you this annual report of state and local advocacy accomplishments. Together, we are the architects of a healthier future.

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Tobacco Control 4

Stroke Systems of Care 7

Heart and Stroke Public Funding 11

Nutrition 13

Physical Education and Physical Activity 15

Acute Events 18

Access and Quality of Care 20

Voices for Healthy Kids 22

Focus on

Mark SchoeberlExecutive Vice President, Advocacy and Health Quality

PROJECT MANAGER Jeff Ranous ChiEf WRiTER Lindsay Lintelman COPyEdiTOR Ashley Bell dEsiGNER Dave Williams

Alabama 3

Alaska 19

Arizona 19

Arkansas 17

California 19

Colorado 17

Connecticut 12

Delaware 14

Florida 3

Georgia 3

Hawaii 19

Idaho 21

Illinois 6

Indiana 6

Iowa 6

Kansas 6

Kentucky 16

Louisiana 3

Maine 12

Maryland 10

Massachusetts 12

Michigan 8

Minnesota 8

Mississippi 3

Missouri 8

Montana 21

Nebraska 9

Nevada 21

New Hampshire 12

New Jersey 12

New Mexico 17

New York 14

North Carolina 10

North Dakota 9

Ohio 16

Oklahoma 17

Oregon 21

Pennsylvania 16

Puerto Rico 3

Rhode Island 14

South Carolina 10

South Dakota 9

Tennessee 6

Texas 17

Utah 21

Vermont 14

Virginia 10

Washington 21

Washington, DC 9

West Virginia 16

Wisconsin 9

Wyoming 19

AlabamaThe Department of Public Health and State Board of Health added critical con-genital heart defects to the list of required screenings by state birthing facilities. This requirement developed in response to the story of Mary Beth Miller, whose personal battle with heart disease served as the impetus for our work on this issue. Now all 52 birthing facilities in the state are screening infants for heart defects.

In addition to this state-wide success, local communities were also hard at work during the legislative session. With the valuable help of volunteers, local cam-paigns gained momentum yielding the passage of strong smoke-free laws in five cities. These victories will protect more than 83,000 people from hazardous sec-ondhand smoke.

FloridaThe state budget included funding and provides authority to the Department of Health to begin rulemaking which will require pulse oximetry screening of all newborns. The Department of Health will still need to put the necessary regulatory requirements in place to ensure all new-borns in the state are screened.

The Tobacco Free Florida program received funding of $65.6 million from the state’s budget. Stronger performance measures were instituted requiring fund recipients to use best practices designated by the CDC in order to achieve smoking cessation results. These performance mea-sures will allow the program to extend its reach and help more individuals develop healthier lifestyles.

GeorgiaThe governor signed a bill requiring all students to receive hands-on instruction in CPR before they graduate as part of the existing health or physical education class. Considering most cardiac arrests occur outside of a hospital, it is impor-tant to equip the next generation with

lifesaving skills so they can respond in an emergency.

The governor also signed another leg-islative priority of the association which removes liability from schools if they choose to open their facilities to public access after school hours. Public access will provide convenient facilities which will encourage children, families and community members to engage in more physical activity.

LouisianaThe governor signed a bill mandating all birthing facilities conduct pulse oximetry screenings on newborns. This decision will extend life-saving technology to every child born across the state, identify-ing serious health problems before they become critical.

The governor also signed a bill requiring each college to develop a smokefree air policy. While the designa-tion of smokefree environments remains a hard-fought battle, this legislation brings the state a step closer to protecting their citizens from the harmful effects of sec-ondhand smoke.

MississippiThe governor signed a bill establishing an interagency Farm to School Council to facilitate the purchase and use of locally grown agricultural products in school meals. This will improve the quality of food served in schools while simultane-ously strengthening local economies, improving the livelihood of local farmers, and spurring additional spending on other local products and services.

Support for smokefree environments increased with the help of many hard-working volunteers. Local smokefree grassroots coalitions passed nine com-prehensive smokefree ordinances. With these additions, there are now 68 local ordinances in Mississippi ensuring people across the state are breathing smokefree air.

Puerto RicoThe association made some significant changes in Puerto Rico this year. At the end of 2012, with the help of a USDA statement and the Puerto Rico Food Sup-pliers Association, advocates were able to put a temporary hold on a program which authorized the use of food stamps by senior citizens and indigents at fast food restaurants.

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Greater SoutheastAffiliATE

You’re the Cure advocates join the Tennessee Obesity Taskforce in March for their annual Day on the Hill activities, urging legislators to support healthy food financing initiatives.

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fOCus ON: tobacco control

Tobacco use is the leading controllable risk factor for cardiovascular disease and stroke in this country. Approximately 440,000 deaths are caused in the U.S. as a result of smoking or secondhand smoke. About 35 percent of all tobacco deaths are related to heart disease, stroke and other cardiovascular diseases.

In order to reduce tobacco use and improve health, the association strongly supports regulation of the manufacture, sale, labeling, advertising and marketing of tobacco products. The association focuses on a multi-pronged approach which includes advocating for smoke-free air policies, increasing excise taxes on tobacco and working to make sure that tobacco prevention and cessation programs are well-funded.

Smoke-free air policiesA 2006 report of the U.S. Surgeon General states that, “There is no risk-free level of exposure to secondhand smoke. Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25 to 30 percent and lung cancer by 20 to 30 percent. The finding is of major public health concern due to the fact that nearly half of all nonsmoking Americans are still regularly exposed to secondhand smoke.”

Among the findings linking secondhand smoke to death and disease among adults and children are:

• Some 126 million non-smokers are exposed to secondhand smoke, increasing their risk of developing heart disease 25-30 percent.

• Tens of thousands of non-smokers die every year of coronary heart disease because they are exposed to other people’s smoke.

• Only smoke-free buildings and public places truly protect non-smokers from the hazards of breathing in other people’s tobacco smoke.

A September 2009 report published in Circulation: Journal of the American Heart Association found that one year after passing smoking bans, communities in North America and Europe had 17 percent fewer heart attacks compared to communities without smoking restrictions, and in those communities, the number of heart attacks kept decreasing with time.

The one effective way to prevent secondhand smoke exposure is to guarantee smoke-free air. The association holds the conviction that legislators and community leaders must rise to the task of protecting all citizens equally, whether in the workplace or any indoor public place. As a result of the work of advocates from across the country, almost 80 percent of Americans now live in a community that has a smoke-free workplace law. About 49 percent of Americans live in a community that is covered by a comprehensive smoke-free law that includes all workplaces including restaurants and bars.

The association advocates for comprehensive smoke-free workplace laws at the state and local levels. The association recommends that smoke-free laws apply to all indoor workplaces and public environments, that there should be no preemption of local ordinances, and no exemptions for hardship, opting out, or ventilation. Other exemptions to avoid include those for casinos and gaming organizations, bars, and private clubs.

The more expensive tobacco is, the less it is usedTobacco tax increases are one of the most effective ways to reduce smoking and other tobacco use, especially among kids. According to the Campaign for Tobacco-Free Kids (CTFK), every 10 percent increase in cigarette prices reduces youth smoking by about seven percent and total cigarette consumption by about four percent. The association’s support of increased excise taxes on cigarettes is producing impressive results. In every state that has significantly raised its cigarette tax rate, pack sales have gone down sharply. The average state cigarette tax is now $1.53 per pack of 20 cigarettes, up from 42 cents per pack in 2000. This is in addition to a federal tax of $1.01. Higher tobacco taxes also save money by reducing tobacco-related health care costs, including Medicaid expenses. States can realize even greater health benefits and cost savings by allocating some of the revenue to programs that prevent children from smoking and help smokers quit.

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Prevention efforts save lives and save moneyCombining state excise tax increases with a comprehensive statewide tobacco prevention campaign accelerates, expands and sustains the decline of tobacco use in the state, thereby saving more lives from cardiovascular diseases. As a result of the Master Settlement Agreement between the tobacco companies and 46 State Attorneys General in the 1990s, hundreds of millions of dollars are paid to states each year.

Advocates worked hard to make sure legislators continue to allocate substantial funds for statewide tobacco prevention campaigns. State tobacco prevention efforts prevent kids from smoking, helping smokers quit, protecting non-smokers from secondhand smoke and reducing tobacco-caused health care costs.

During this past year we have seen significant progress in each of these key areas and below are highlights of those victories:

• Legislators in iowa increased funding for the state tobacco control program. The $1.5 million increase will allow for more programs to help keep kids from starting to use tobacco and help current tobacco users quit.

• Massachusetts raised the tobacco tax – by $1.00 per pack. The new tax brings the total state cigarette tax to $3.51 per pack; among the highest taxes in the nation. This will also save thousands of lives and dramatically reduce health care costs.

• In May the governor of Minnesota signed into law a $1.60 per pack tobacco tax increase. This was a major victory for tobacco prevention efforts in the state. The new tax will prevent more than 47,700 Minnesota kids from becoming smokers, spur more than 36,600 current adult smokers to quit, save more than 25,700 Minnesota residents from premature, smoking-caused deaths and save more than $1.65 billion in future health care costs.

• In Oregon, the legislature allocated $2 million in new annual funding for the state’s tobacco prevention and cessation program. These funds will come from the Master Settlement Agreement (MSA) funds, marking the first time Oregon will use MSA funds as originally intended.

These are just a few of the recent tobacco prevention highlights.

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After the association’s continued lobbying against the initiative, the newly elected governor and Secretary of Family Affairs announced the elimination of the program.

Then advocates joined with the American Cancer Society and the American Lung Association to resume efforts toward increasing the cigarette excise tax. When this campaign started five years ago, the legislature did not react positively. However, as a result of the financial crisis and the budget defi-cit, the government needs new revenue sources. The association fought hard this year to secure a $1.00 cigarette tax increase. In addition to this immediate increase, in July of 2015 the tax will increase again by 17 cents bringing the

total tax per pack to $3.40. The law also increased the tax on smokeless tobacco products.

TennesseeThe association wrapped up a produc-tive legislative session by accomplish-ing important policy changes. A bill passed that requires health care provid-ers to give instruction in infant CPR to at least one guardian of a newborn before discharge from the hospital. This simple additional procedure will equip countless parents with life-saving knowledge.

Advocates also took a stance on tobacco by supporting the creation of a

Class A misdemeanor for the selling of smoking paraphernalia from anywhere but behind the counter of a retail estab-lishment or in a locked display case. By gaining more control over distribution, these regulations will contribute largely to ongoing efforts in tobacco control.

The governor included $20 million for a “Health and Wellness Initiative” to focus on obesity, diabetes, heart disease, and other health issues related to air, water, and environmental con-cerns. Although the appropriation is contingent upon sufficient funds from a Tobacco Master Settlement Agreement, the association remains confident that the state will benefit from this legisla-tion in many ways.

Greater Southeast affiliate continued from page 3

IllinoisAdvocates were successful in their work to pass a $1 per pack Cook County ciga-rette tax increase. This will help reduce smoking rates and improve air quality for more than five million residents. Then, through the efforts of an association-led coalition, a pulse oximetry bill made it through nine committee and floor votes prior to passage in both houses. We expect to see this issue through to frui-tion in the coming year. Advocates also led another coalition: the Illinois EMS Alliance. This coalition championed several important bills to bring needed resources and smart reforms to the strug-gling Illinois EMS system. We expect the progress made last year to strengthen Illinois’ critical systems of care into the coming year.

IndianaThanks to the association’s hard work during this legislative session, Hoosiers who want to become more physically active will now have an additional access point in their community. The legisla-ture approved a bill that allows schools to share their physical activity facilities (gyms, running/walking tracks, multi-purpose rooms) with the community for recreation and exercise opportunities. The association led the way to this vic-tory by securing a legislator who was formerly a school board member and understood the need to use public facili-ties, to author the bill. With the help of many advocates, the bill received broad support in both the House and Senate.

IowaThe association worked for over a year to ensure all newborn babies receive a pulse oximetry screening for critical

congenital heart defects. After a long and hard battle, including the sharing of many personal stories, advocates pre-vailed when the governor signed the bill into law.

A $1.5 million increase in funding to the Tobacco Use Prevention and Control Program was secured and will provide assistance to many who seek smoking cessation. Iowa also produced a new Health and Wellness Plan, the state’s own design for Medicaid expansion, providing health coverage to 150,000 uninsured, working Iowans.

KansasThe association received a $433,000 grant from the Kansas Health Foundation to promote healthy foods and beverages. By leveraging the resources made avail-able through this grant the association is now seen as an established leader on obesity policy within the state.

MidwestAffiliATE

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fOCus ON: stroke systems of care

stroke continues to be a significant cause of death and disability in the United States. Stroke remains the forth leading cause of death in the United States is a leading cause of serious, long-term disability.

Major advances have been made during the past several decades in stroke prevention, treatment, and rehabilitation. Despite successes in delivering effective new therapies, significant obstacles remain in ensuring that scientific advances are consistently translated into clinical practice. In many instances, obstacles to stroke care can be related to a fragmentation of care caused by inadequate integration of the various facilities, agen-cies, and professionals that should closely collaborate in providing stroke care. In order to alleviate this frag-mentation, the American Heart Association / American Stroke Association advocates for the development of stroke system of care which address: primordial and primary prevention; community education; notification and response of emergency medical services for stroke; acute treatment for stroke; sub-acute stroke care and secondary prevention for stroke; rehabilitation of stroke patients, and continuous quality improvement initiatives.

A stroke system of care provides each patient seamless transition from one stage of care to the next with the highest quality at each step, including the abil-ity to overcome barriers that might interfere with stroke care. By employing a systems approach to stroke care statewide, it becomes possible to analyze data from each step of the continuum of care and determine what measures of care work best. It is then possible to apply these findings across the region to improve care for all patients. The association continues to coordinate state stroke systems implementation in each of the 50 states. This effort includes working with partners and stakeholders involved in stroke care to assess each state’s current level of stroke care, evaluate available resources, and identify opportunities for improvement and implement needed improvements. Here are a few highlights of successful activities this past year:

• In Colorado a bill was passed which requires the Department of Public Health and Environment to recognize nationally accredited hospitals as STEMI receiving/referring and primary/comprehensive stroke centers.

• A resolution was passed in hawaii that establishes a State Stroke Task Force to focus on improving the state’s stroke system of care. The resolution includes a request for the Task Force to establish a stroke database and registry and consider using Get With The Guidelines-Stroke as the means to collect and report data.

• In Minnesota the association helped the state estab-lish a system for stroke hospital designation. Knowing the stroke care capacity of hospitals prior to arrival will save time and, therefore, improve the outcome of stroke patients.

• Culminating off a ten-year effort, Missouri developed stroke and STEMI registries that use Get With the Guidelines and Action Registry-Get With the Guide-lines as the data platforms. This plan also creates a comprehensive stroke and STEMI system of care, building the capacity to improve the outcomes of many acute event patients.

• New Mexico advocates pushed for a bill that allows the Department of Health to recognize nationally accredited hospitals as STEMI receiving/referring centers, helping more stroke patients receive care from qualified institutions. The association also gar-nered $250,000 in appropriations for the establish-ment of statewide stroke and heart attack registries

• North Carolina advocates saw the successful enact-ment of legislation that sets up a process by which the state will formally recognize Primary Stroke Centers.

• North dakota secured $383,000 to augment ongoing to efforts to improve the state’s stroke system of care.

• Advocates established a statewide Stroke Registry and Stroke Care Committee in Oregon to collect data and improve the outcomes of stroke patients.

• The association protected $50,000 in funding which is earmarked to help implement a comprehensive Stroke System of Care in south Carolina.

• In Texas, advocates secured a $4.5 million appropria-tion for the Lone Star Stroke Consortium.

• In Virginia advocates partnered with Mission: Lifeline volunteers to persuade the state’s General Assembly to include $400,000 for 12-lead electrocardiograms for emergency medical services trucks in its final budget.

• Wyoming passed a law that allows the Department of Health to recognize nationally accredited hospitals as STEMI receiving/referring and primary/comprehensive stroke centers.

Implementation of stroke systems of care across the country will lead to improved stroke care assess-ment, treatment, prevention and awareness of stroke—all important efforts at reducing the third cause of death in this country and improving the health of Americans from coast to coast.

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Midwest affiliate continued from page 6

Although obesity issues took center stage, advocates successfully lobbied the legislature to push back an attempt to eliminate the charitable contribu-tion deduction from state income tax, preserving a valuable incentive for charitable giving. The association also worked to initiate a campaign to recom-mend that all newborns be screened for critical congenital heart disease before being discharged from the hospital. The association will continue work on that issue in the coming session.

Once again, the association and coalition partners defeated an attempt to weaken the popular clean indoor air law, maintaining a firm stance on this ongoing issue.

MichiganThe association worked to advance legislation that would require schools to have an emergency cardiac response plan. Parents of student-athletes who experienced sudden cardiac arrest testi-fied in support of the bill, resulting in a unanimous vote from the House. Advo-cates hope to report a victory on this bill in 2014

The association also mobilized advocates to express concerns to law-makers over an amendment to allow sports and other activities in lieu of physical education (PE) for high school graduation. The association will

continue working to ensure PE remains a graduation requirement as the bill moves to the Senate.

The association worked with a diverse coalition of stakeholders to advocate for the expansion of Medic-aid eligibility to include up to 133% of the federal poverty level. The reform efforts, as recommended by the Afford-able Care Act, will result in as many as 470,000 currently uninsured state resi-dents being covered moving forward. The coverage will grant these individu-als access to both preventative services and care for chronic cardiovascular conditions. The law goes into effect in the spring of 2014.

MinnesotaAdvocates were able to see the results of their work when they attended a bill signing resulting in a $1.60 increase in the price of tobacco in the state. According to research, this effort may potentially save as many as 26,000 citizens from premature death due to smoking.

The association successfully advo-cated for appropriations that will fund two critically important programs. First, the Statewide Health Improvement Pro-gram (SHIP) received funding at $35 million per biennium. SHIP works to improve healthy eating, increase physi-cal activity, and reduce tobacco use

across the state. Previously, only about half of the state’s counties receive fund-ing through SHIP. However, with the addition of these new funds, SHIP will reach nearly the entire state with these important prevention strategies. Second, the Safe Routes to School (SRTS) pro-gram obtained an allotment of $500,000 per biennium. This funding will help communities plan SRTS programs, pro-vide training for staff and volunteers to support SRTS, and assist with crucial non-infrastructure costs involved with a successful SRTS program.

The association helped the state establish a system for stroke hospital designation. Knowing the stroke care capacity of hospitals prior to arrival will save time and, therefore, improve the outcome of stroke patients. Advocates were also successful in their efforts to pass a bill requiring all newborns receive screening for critical congenital heart defects.

MissouriThe association worked closely with the March of Dimes to lead efforts in passing a law that requires pulse oxim-etry screening for all newborns. The association also worked to improve the life-saving care provided to victims of stroke. In the culmination of a ten-year effort, Missouri developed stroke and ST Segment Elevated Myocardial Infarction (STEMI) registries that use Get With the Guidelines and Action Registry-Get With the Guidelines as the data platforms. This plan also creates a comprehensive stroke and STEMI system of care, building the capacity to improve the outcomes of many acute event patients.

Advocates campaigned for con-tinued funding of the WISEWOMAN program, helping underinsured and low income women obtain screenings to prevent against heart disease and stroke. The association was also successful in passing a comprehensive smokefree law in the City of Sedalia.

Surrounded by advocates from the state tobacco coalition, Governor Mark Dayton of Minnesota signs a bill increasing the price of tobacco by $1.60.

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NebraskaAdvocates were successful in their campaign to pass an appropriation of $150,000 for cardiac monitors to be used by rural EMS rescue services. Outfitting rescue services with 12-lead electrocar-diogram (ECG) cardiac monitors and training EMS personnel in identification of ST segment elevation myocardial infarction (STEMI) is crucial for closing the gap in the system of care.

Another success was the enactment of a new law that will require screen-ings for critical congenital heart defects (CCHD) for the state’s newborns. One of Nebraska’s valuable advocates for this bill was 11-year old Cole Klein. Born with CCHD, Cole testified in support of the pulse oximetry bill. This young man left an impression on the legisla-tive committee with his final message: “Screening for babies for heart defects will give many children, like me, a fight-ing chance. A chance we need; a chance I think we should have.”

North DakotaThe association saw the enactment of four key policy priorities. These include a statewide, 100% smokefree law that was overwhelmingly approved by voters; critical congenital heart defect screenings

using pulse oximetry; and passage of an acute cardiovascular emergency bill that includes a ST Segment Elevated Myo-cardial Infarction (STEMI) registry and STEMI receiving facility designation.

The association also saw a number of key appropriations successes. CPR in schools received $450,000 and stroke system funding obtained an increase of $383,000. Combined with base funding from prior sessions, the association has successfully advocated for over $1.3 million in funding for key heart and stroke efforts. Advocates also secured a portion of a new state staffing posi-tion to enhance the significant work on acute cardiovascular systems of care. The association joined with many other groups for the passage of Medicaid Expansion.

South DakotaThe state’s busy legislative session culminated with the passage of a bill that ensures all newborn babies will be screened for critical congenital heart defects by pulse oximetry. This bill gained support during a legislative reception the association held in partner-ship with the South Dakota Emergency Medical Technicians. This proved to be a great opportunity for us to engage and educate legislators about the benefits of

pulse oximetry screening. The associa-tion secured several legislative champi-ons on this bill which allowed the bill to face little opposition through committee and floor discussions.

WisconsinThe association managed to fend off pro-posed cuts to the Tobacco Prevention and Control Fund and defeated a proposal that would have imposed a surcharge on smokers’ health insurance premiums. The association also campaigned for $2 million to go toward Safe Routes to School projects and prevented the elimi-nation of a program designed to promote healthy local food systems, including Farm to School initiatives.

In addition to these hard fought bud-get successes, advocates also advanced legislation to ensure all newborns receive screening for critical congenital heart defects prior to hospital discharge. The association delivered over 1000 signed petitions in support of the legislation. Efforts on this legislation will continue in 2014. The association also helped create a legislative study committee to strengthen the state’s 9-1-1 system. The committee met over the fall and winter months and proposed six initiatives that the association will move forward in 2014.

Mid-AtlanticAffiliATE

District of ColumbiaAdvocates proudly report the passage of the DC Telehealth Reimbursement Act of 2013. With this law, the District of Columbia joined a growing list of states to pass legislation requiring all payers to reimburse services rendered by telehealth.

The Shared Use of School Property in the District Act, which attempts to

make school property available to com-munity members for recreational and athletic activities, was introduced in May. The association also advocated for the DC Worksite Wellness Act. This bill would increase access to healthier foods and beverages sold through vending machines and on site food services on District property, encouraging healthy eating habits among DC employees.

Finally, the association backed the DC Stroke Systems of Care Act with hopes to create a comprehensive stroke system of care to improve the quality of care and outcomes of stroke patients. The association’s work on these bills estab-lished a strong foundation to build upon in the coming year.

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MarylandAs a result of advocates’ efforts, the state now requires Medicaid to reim-burse care delivered through telemedi-cine technology specific to emergency cardiovascular and stroke emergencies anywhere in the state. A complimentary bill clarifies the credentialing process for telemedicine providers. In April, the state finalized regulations requiring that all newborn babies across the state receive screening for critical congenital heart defects using pulse oximetry.

The association also supported two bills that require CPR training for high school graduation. The bills called for the training to involve psychomo-tor skills and remain consistent with the association guidelines. While the bills ultimately failed in committee, the association built a strong foundation for success in the future including a cadre of cardiac arrest survivor advocates from across the state.

North CarolinaAdvocates geared up for the 2013 legis-lative session with an impactful teddy-bear-shaped postcard campaign in support of legislation for pulse oximetry newborn screening. Efforts then contin-ued with a tour of Vidant Health’s Pri-mary Stroke Center in Greenville where advocates provided in-person educa-tion to lawmakers about methods of

improving stroke care. These influential activities set the stage for a productive legislative session. For the first time, advocates saw the governor sign two of the association’s bills into law on the same day: one requiring pulse oximetry newborn screening and another desig-nating Primary Stroke Centers.

The hard work did not stop there. Advocates also protected non-profit issues in tax reform, amended e-cig-arette legislation, and secured $1.2 million in recurring state funds for QuitlineNC, a free service available to any resident that needs help quitting tobacco use. Further still, the associa-tion collaborated with partners to host High Blood Pressure Awareness Day and an exciting news conference featur-ing the Speaker of the House and his plans to promote worksite wellness at the legislature. This commitment from the Speaker sets an excellent example that will encourage businesses across the state to invest in the health of their employees.

South CarolinaThe governor signed the Emerson Rose Act into law, requiring hospitals to perform screening to detect critical congenital heart defects in newborns. The law will go into effect this year. This legislation also allows the associa-tion to clarify that pulse oximetry be the tool used for screenings through the

regulatory process. Additionally, leg-islation for CPR in Schools passed the Senate and will carry over into the 2014 session for consideration in the House. The bill requires hands-only CPR train-ing as part of the high school health education curriculum.

The association also spent time securing funds in this fiscal year’s budget. First, the association fought for tobacco prevention and cessation programs. As a result of hard work from advocates, these programs will remain fully funded using revenue gen-erated from the cigarette tax. Next, the association protected a one-time fund-ing of $50,000 to help implement the Stroke Systems of Care Act. In light of the tight budget times, these were big achievements.

Finally, seven municipalities went smoke-free in the 2013 session, includ-ing Hartsville, Charleston County, Lan-caster County, and Goose Creek. The state now has 54 comprehensive smoke-free ordinances protecting 38.8% of the population from the harmful effects of secondhand smoke.

Virginia“Gwyneth’s Law” will require that all high school students in the state receive training in CPR before graduation, beginning with the freshman class of 2016. The law will also require that all teachers in the state be trained in this life-saving skill as a condition of their licensure. The bill was named after 13-year old Gwyneth Griffin, who died in July 2012 after suffering a cardiac arrest at school. The association staff proudly partnered with Gwyneth’s par-ents, Joel and Jennifer Griffin, in pass-ing this important legislation to honor their daughter.

The association staff partnered with Mission: Lifeline volunteers to per-suade the state’s General Assembly to include $400,000 for 12-lead electrocar-diograms (ECGs) for emergency medi-cal services (EMS) trucks in its final budget. These funds will help equip more EMS systems throughout the commonwealth with these important, time-saving devices.

Mid-Atlantic affiliate continued from page 9

Governor Patrick McCrory of North Carolina is joined by You’re the Cure advocates and bill sponsors as he signs the pulse oximetry legislation into law.

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fOCus ON: heart and stroke public funding

An estimated 83 million u.s. adults suffer from cardiovascular diseases (CVD). These life threatening conditions include coronary heart disease, heart failure, stroke, and high blood pressure. More than 2,200 peo-ple die of CVD each day—one death every 39 seconds.

The American Heart Association and American Stroke Association have a strong history and tradition of advocating for an increased investment of public funds to combat heart disease, stroke and the risk factors that cause them. By championing public funding for cardio-vascular disease and stroke prevention programs and actively partnering with our public health partners and agency authorities, we can help ensure that financial resources are available to help support and enhance life-saving state and community programs.

The association supports efforts to:

• Protect general fund appropriations for cardiovascular programs already in place;

• Identify and seek new sources of public funding;

• Ensure states are fully applying for and leveraging available federal funds; and

• Secure dollars that flow directly to the heart disease and stroke prevention units in state health departments.

While the association worked this past year to increase funding for cardiovascular disease programs and other public health initiatives, we also worked hard to preserve existing fiscal support. Some of this year’s public funding successes include:

• In Alaska the Governor recently included an increase of $1 million for the Obesity Prevention and Control Program in the state budget. The State of Alaska will now have $1 million for initiatives such as working with school districts to upgrade their wellness policies, physical education curriculum trainings for PE teachers from across the state, deployment of locally grown vegetables from the Alaska Farm to School program into more schools, a pilot project to allow the use of EBT cards at Farmers Markets, and state trainings for rural educators on childhood obesity and school nutrition issues.

• The State of Massachusetts created a Prevention and Wellness Trust Fund to pay for programs to stem chronic illnesses such as diabetes, asthma, and heart disease that are fueling the growth of medical costs. The $60 million earmarked over the next four years for the Prevention and Wellness Trust will be paid for by a tax on insurers and an assessment on some larger hospitals. Under the expansive prevention program, communities, health care providers, regional-planning

agencies, and health plans will be able to vie for grants, to be awarded by the state’s Department of Public Health, to battle preventable illnesses.

• In Minnesota the association successfully advocated for appropriations that will fund two critically important programs. First, the Statewide Health Improvement Program (SHIP) received funding at $35 million per biennium. SHIP works to improve healthy eating, increase physical activity, and reduce tobacco use across the state. Previously, only about half of the state’s counties received funding through SHIP, but with the addition of these new funds, SHIP will reach nearly the entire state. Second, the Minnesota Safe Routes to School (SRTS) program obtained an allot-ment of $500,000 per biennium. This funding will help communities plan SRTS programs, provide training for staff and volunteers to support SRTS, and assist with crucial non-infrastructure costs involved with a suc-cessful SRTS program.

• In Oregon the recently adopted state budget includes an allocation of $4 million for physical education grants. The funds will be available to all schools from grades Kindergarten through Eighth through a com-petitive grant process to help train and fund PE teach-ers, helping provide more children with quality and adequate physical activity throughout the school day.

• In Rhode island advocates secured state funding to supplement a federal grant awarded to the state for the WISEWOMAN Program. This funding will provide vital preventive services to low-income, uninsured and underinsured women, improving the quality of health care for many citizens.

• In south Carolina the association protected a one-time funding of $50,000 to help implement the Stroke Systems of Care Act after the bill was initially vetoed by the governor.

• In Tennessee the governor included $20 million in the state budget for a “Health and Wellness Initiative” to focus on obesity, diabetes, heart disease, and other health issues related to air, water, and environmental concerns. Funds are contingent upon the Tobacco Master Settlement Agreement.

• In the State of Texas the association was able to secure $500,000 in the state’s 2014–2015 budget bill for Stroke/STEMI data registries, increasing the pool of data for continued research aimed at improving stroke care. In addition to this, advocates gained $4.5 million for the Lone Star Stroke Consortium. Together these policies create a well-designed attack on heart disease and stroke.

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ConnecticutAdvocates promoted successful legisla-tion creating a Childhood Obesity Task-force which is charged with working to address a number of issues related to the association’s obesity prevention policy goals. These issues include examining the nutrition standards for all food procured by the state, exploring ways to increase physical activity throughout the school day, and reforming the state’s food pur-chasing practices.

Advocates also worked aggres-sively to increase the state’s cigarette tax. Although the governor held firm on not raising consumer taxes, the association’s campaign positioned the issue as a top revenue option for the 2015 biennium budget. The association then promoted CPR in schools legislation by hosting a reception where legislators took part in CPR demonstrations. Advocates will con-tinue campaigning for the passage of these two policies next year.

MaineThe hard work of advocates resulted in two significant policy advancements this year. First, the association worked on securing appropriations for heart disease and stroke priorities, including restoring cuts to tobacco cessation benefits. The benefits were restored, bringing the state up to United States Preventive Services Task Force best practice standards for Medicaid tobacco cessation. The associa-tion expects this bill to become law soon after the legislature reconvenes in January.

The association supported a policy that requires birthing facilities to perform a pulse oximetry screening on every new-born prior to discharge. This bill became law without the governor’s signature in July. However, the bill did not explicitly call for pulse oximetry to be the required screening tool. The association will con-tinue to work to add a pulse ox require-ment during the rulemaking process.

MassachusettsDuring the 2013 legislative session, advo-cates worked with a coalition of consumer and public health groups to secure funds to pay for programs to reduce medical costs by stemming chronic illnesses such as diabetes, asthma, and heart disease. The state earmarked $60 million over the next four years for the Prevention and Wellness Trust, the first such state-based preven-tion fund in the nation. This fund is set up to reduce rates of the most prevalent and preventable health conditions, increase healthy behaviors, address health dispari-ties, and develop a stronger evidence-base of effective prevention programming. Under this program, communities, health care providers, regional-planning agen-cies, and health plans will be able to vie for grants from the state’s Department of Public Health. The association’s dedica-tion to this issue will provide the means for the state to take multiple approaches in the battle against preventable illnesses.

New HampshireSince 2010, the association has actively engaged in creating a stroke system of care in the state through the newly named Stroke System Collaborative. This

association-led committee has represen-tation covering all components of the stroke system and has worked to convince hospitals to support the creation of a state data registry using the Get With The Guidelines® (GWTG) as the tool. During a statewide Stroke System Conference held in April, GWTG-Stroke hospitals and other Stroke Steering Committee mem-bers led breakout sessions and shared the success they have had establishing stroke programs and working with EMS provid-ers to set up Stroke Alert systems. With continuing effort in this area, the asso-ciation hopes to improve the care of all stroke patients across the state.

New JerseyIn 2013, advocates labored for policy addressing sudden cardiac arrest response. Janet’s Law, named for 11 year old Janet Zilinski who died of cardiac arrest dur-ing cheerleading practice in 2006, passed both houses unanimously. The law will require schools to have an automated external defibrillator onsite during school hours and at all school sponsored sport-ing events. It also requires training for certain school personnel and development of a medical emergency response plan.

Senator Tony Guglielmo of Connecticut at a CPR in schools statehouse event.


FoundersAffiliATE

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fOCus ON: nutrition

Along with regular exercise, weight management, and not smoking, a healthy diet is proven to reduce the risk of cardiovascular disease (CVD), stroke and other chronic diseases and conditions. In fact, following healthy dietary guidelines—such as those recommended by the American Heart Association—is one of the best, easiest, and smartest ways for individuals to take control of their heart health. Even small changes can bring long-term benefits. Too many Americans are still eating too many foods high in saturated and trans fats, cholesterol, added sugars, salt, and refined grains. They are eating more food away from home, portion sizes are larger, and calories are higher. The childhood obesity epidemic also points to the need to educate kids about making better food choices at a young age.

The many benefits and challenges presented by a heart-healthy diet are clear. The association supports policy and regulatory efforts at the federal, state, and local levels to promote greater awareness of the importance of a healthy diet and to provide all Americans with greater access to nutritious foods. Policy recommendations include:

• Work to eliminate food deserts and improve access and affordability of healthy foods.

• Strengthen nutrition standards in schools for meals and competitive foods and in all government nutrition assistance or feeding programs.

• Require calorie information to be displayed on menus and menu boards in all restaurants with standardized menus and recipes.

• Continue to monitor the removal of industrially produced trans fats from the food supply and assure the use of healthy replacement oils.

• Address food marketing and advertising to children.

• Limit added sugar and sodium in the food supply.

Some of the year’s highlights include:

• The Cincinnati City Council adopted a city budget which includes $5 million for the creation of a new fund that will help build grocery stores in “food desert” areas of the city. Thousands of children in Cincinnati live steps away from the nearest junk food but miles away from fresh produce and other health eating options. Recent national economic trends have made this situation worse. The fund created by the city of Cincinnati follows a

strategy proven successful in improving health in Philadelphia and a growing

number of other locations around the country.

• In Connecticut advocates successfully promoted legislation that created a Childhood Obesity Taskforce to address a number of

issues related to the association’s obesity

prevention policy goals. These issues include examining the

nutrition standards for all food purchased by the state, exploring ways to increase

physical activity throughout the school day, and reforming the state’s food purchasing practices.

• In Kansas the association received a $433,000 grant from the Kansas Health Foundation to promote healthy foods and beverages. By leveraging the resources made available through this grant, the

association is now seen as an established leader on obesity policy within the state.

• In Mississippi the governor signed a bill that will establish an Interagency Farm to School Council to facilitate the procurement and use of locally grown agricultural products in school meals. This will improve the quality of food served in schools and simultaneously generate new income for farmers.

• In Wisconsin the association prevented the elimination of a program designed to promote healthy local food systems, including Farm to School initiatives.

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The bill was signed by the governor and will go into effect September 2014.

Advocates also hosted the first ever state lobby day involving a Hands Only CPR demonstration. As a result, several legislators showed interest in sponsoring a bill to make CPR training a high school graduation requirement. The association hopes to see this bill become a law in the coming year.

New York CityThe association made great strides in the effort to offer quality physical education (PE) to every kid in the city. This past February, the association’s Advocacy Committee released the results of a sur-vey detailing the status of PE in the city’s schools. More than 270 schools at all grade levels and across all five boroughs participated. Unfortunately, the survey revealed troubling results. More than half of schools did not meet the state-man-dated requirements, many did not have a certified PE teacher on staff, and some reported as many as 150 students in one class. This report helped shape a series of policy recommendations that advocates shared with City Council members during an association lobby day. Thanks to hard work from volunteers, the association expects the Council to take action this fall.

New York StateThroughout the year, advocates and vol-unteers pushed for a big piece of legisla-tion for small hearts: the pulse oximetry bill. During the campaign, the bill faced

trouble in the Senate. However, some-thing special happened in the halls of the Capitol that lead to final victory. Public servants, advocates, and visitors to the Capitol smiled when they saw a group of small children in superhero capes walking the halls. The association’s littlest advo-cates and their families were there to sup-port the passage of the pulse oximetry bill in the Senate.

Following a press conference where the red caped heroes shared their stories, the smallest heroes met with lawmakers and Senate Leadership to deliver hun-dreds of petitions in support of the pulse oximetry bill. Thanks to their efforts and the outreach of the association, the Sen-ate passed the pulse oximetry bill unani-mously and the governor signed it into law.

Rhode IslandAdvocates made their voices heard with several policy victories this session. The association lead a campaign to require all high school students to receive hands-on CPR training and an overview of auto-mated external defibrillator (AED) use prior to graduation. The bill passed, creat-ing a new generation of lifesavers in the state.

The association also urged the gover-nor to veto a tobacco industry bill related to electronic cigarettes—and he listened. The tobacco industry and electronic ciga-rette vendors claimed the intent of the bill was to protect children by banning the sale of e-cigarettes to minors. However, the bill was a “Trojan Horse” that would

have exempted e-cigarettes from the strict laws that apply to regular cigarettes—laws that the association fought hard to establish.

Finally, advocates secured state fund-ing to supplement a federal grant for the WISEWOMAN Program. This funding will provide vital preventive services to low-income, uninsured and underinsured women, improving the quality of health care for many citizens.

VermontThe association worked hard in 2013 for funding and strategic tax increases. First, advocates secured $3.9 million for the Tobacco Control Program. Then, the association advocated for legislation that would impose a penny per ounce excise tax on sugar sweetened beverages. This increase could reduce consumption of these beverages and simultaneously pro-vide funding for public health initiatives to combat obesity. The legislation looked promising until it fell short in the Ways and Means Committee by just one vote. The association expects the tax to become a reality in the next few years.

Advocates also made great progress in advancing a tobacco tax increase that popped up mid-session. After several hearings, a vote that the tax was not ger-mane to the bill brought the legislation to a halt. However, with 75% of the public supporting a $1.25 increase, the associa-tion hopes to see this tax gain approval next year.

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DelawareAdvocates proudly supported pub-lic policy that requires screening for critical congenital heart defects in all

newborns with pulse oximetry before leaving the birthing facility. This simple procedure brings comfort to many new parents as they take their children home for the first time.

Advocates organized CPR instruc-tion for legislators and their staff. Students from a local high school provided the instruction and presented all legislators with CPR Anytime kits.

Great RiversAffiliATE


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The quality and quantity of physical education in the nation’s schools is an important part of a student’s comprehensive, well-rounded education program and a means of positively affecting life-long health and well-being. The optimal physical education program will foster a long-term commitment to physical activity as part of a healthy lifestyle that will help children prevent chronic disease and numerous other conditions, includ-ing abnormal cholesterol, high blood pressure, obesity, and heart disease. The association advocates for more frequent, quality physical education in all schools. Qual-ity physical education will engage students in health-promoting physical activity for at least half of class time and teach them the knowledge and skills necessary for lifelong physical activity. Quality physical education also should be supplemented, but not replaced, by additional school-based physical activity.

In the School Environment the association’s recom-mendations include:

• 150 minutes per week of physical education for elementary school students.

• 225 minutes per week of physical education for middle school students.

• At least 50 percent of physical education class time should be spent in moderate to vigorous physical activity.

• High schools should make physical education a graduation requirement.

In order for adults and children to get the exercise they need to be healthy, they need places to be active. Research has shown that people who have parks or recreational facilities nearby exercise 38% more than those who do not have easy access. Lower-income communities, especially in predominantly Latino or African-American neighborhoods, often have fewer resources to support active lifestyles and places to play and be active. Shared use agreements allow school districts, local governments, and community- based organizations to overcome common district concerns and share costs and responsibilities of opening school property to the public after school hours.

In the Community Environment the association’s recommendations include:

• Promote efforts within the community environment that will lead to increased physical activity

• Promote built environments that integrate physical activity into daily living

• Support increased use of shared use agreements and street scale improvements in underserved communi-ties including policies that clarify liability rules for the use of school owned recreation facilities.

• Provide safe routes to schools and school sites that offer walking and biking options for most students.

• Support the creation of complete streets.

Highlights this year included:

• In 2013 the association made great strides in the effort to offer quality physical education (PE) to every child in New york City. This past February, the asso-ciation’s Advocacy Committee released the results of its survey research project detailing the status of PE in the city’s schools. More than 270 schools at all grade levels and across all five boroughs participated. Unfortunately more than half of schools did not meet the state-mandated requirements, many did not have a certified PE teacher on staff, and some reported as many as 150 students in one class. This report helped shape a series of policy recommendations shared with City Council members and we expect that they will take action on the recommendations in late 2013.

• In indiana those who want to become more physi-cally activite will now have an additional access point in their community. The legislature approved a bill that allows schools to share their physical activity facilities (gyms, running/walking tracks, multi-purpose rooms) with the community for recreation and exercise oppor-tunities. The bill identifies liability specifications to pro-tect these schools.

• In delaware the association also worked to protect funding for the state’s built environment that promotes designs conducive to walking and biking. The associa-tion’s hard work was able to maintain a line item for this project in the budget, providing opportunities for more citizens to enjoy healthier lifestyles.

• In Georgia the Commissioner of the Department of Public Health announced a plan to collaborate with the Department of Education to add 30 minutes of physical activity to the school day for every elemen-tary school child. Also, the governor signed a bill that removes liability from schools if they choose to open their facilities after hours. This will provide conve-nient and accessible facilities to encourage families and community members to engage in more physi-cal activity. These two accomplishments will have a marked impact on improving the health of the state’s children along with the rest of the public.

fOCus ON:physical education and physical activity

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This effort allowed Delaware to make significant progress with the State Board of Education and Department of Education in working to make CPR a graduation requirement for all students. The foundation established with these efforts will help as the asso-ciation continues to advocate for this critical issue in 2014.

The association worked to protect funding for the state’s built environ-ment that promotes designs conducive to walking and biking. The associa-tion’s hard work was able to maintain a line item for this project in the bud-get, providing opportunities for more citizens to enjoy healthier lifestyles.

KentuckyAdvocates successfully campaigned for the passage of a bill that ensures all newborns are screened for critical congenital heart defects before leaving the hospital. Their efforts will continue into 2014 as they work through the regulatory process to require that pulse oximetry be the screening tool used to implement this lifesaving measure.

The association then launched the third year of the Smoke Free Kentucky cam-paign and made significant progress in this tobacco pro-ducing state. The coalition con-tinued to gain momentum by engaging constituents in lob-bying efforts and uniting the governor, the Kentucky State Chamber of Commerce, and former University of Kentucky and NBA basketball great Derrick Anderson at a rally. Unfortunately, the legislation that passed through the com-mittee with overwhelming sup-port did not have enough votes to make it through the House. However, three communities did pass local smoke free laws, bringing the total number of smoke-free communities to 38 statewide. Kentucky will build on this success in 2014 as the

campaign continues for a comprehen-sive smoke-free bill.

OhioAdvocates held two lobby days to focus legislative attention on their priorities, including pulse oximetry screening for newborns. As a result of their efforts, Senate leadership named the issue to the Senate’s top 10 priority list and ultimately the governor signed the bill in June. The association will continue to work through the regula-tory process next year to ensure full implementation of the law.

Another area of focus was tobacco control. Due to the dismantling of the tobacco control program several years ago, advocates have been working continually to restore state tobacco prevention and cessation funding by equalizing the Other Tobacco Products (OTP) tax with cigarettes. Further-more, the legislature reviewed and upheld Ohio’s comprehensive smoke-free law. The reinforcement of this law

protects the public’s right to breathe clean air.

PennsylvaniaThe top priority for the association this year was a bill to remove loopholes in the state’s smoke-free law. Although the bill was not enacted, a strong foun-dation was laid to continue the cam-paign into next year. The advocates’ dedication moved the state further toward the goal of protecting workers and the general public from the dan-gers of secondhand smoke.

Advocates also supported a bill that would ensure all newborns receive screening for critical congenital heart defects (CCHD) before discharge from the hospital. In response to the intro-duction of this legislation, a “Faces of Hope” campaign featuring the stories of Pennsylvania children with CCHD was launched. This campaign gener-ated much-needed awareness around the issue, creating an opportunity to have the bill considered in 2014.

West VirginiaAfter enacting legisla-tion in 2012 that requires pulse oximetry testing for all newborns, efforts were undertaken through the regulatory process in order to implement the law. Advocates also continued to build the case for an increase in West Virginia’s tobacco taxes. Higher taxes on tobacco would decrease rates of tobacco use and provide additional funding for tobacco prevention and cessation programs. In spite of an aggressive statewide advertising campaign, the bill did not pass. The asso-ciation and coalition part-ners did, however, protect current tobacco prevention funding from serious pro-posed cuts.

JROTC students from Henlopen High School train Delaware lawmakers and their staff members in hands-only CPR at Lobby Day.

Great Rivers affiliate continued from page 14

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ArkansasIn this year’s legislative session, the association passed two key pieces of legislation for youth. To generate support for these bills, advocates held five lobby days throughout the legislative session where state decision makers were invited to speak. The first bill the association pro-moted requires screening for all newborn babies with a pulse oximetry test to detect critical congenital heart defects.

The second bill made CPR a require-ment for high school graduation. This ensures that the teaching and practicing of the psychomotor skills involved in basic life support will remain a permanent com-ponent of the State Education Frameworks. These two policies will help children overcome heart problems and later educate them to do the same for someone else.

ColoradoThis year advocates made progress in improving the process through which stroke patients receive care. With the help of dedicated volunteers, the state passed a bill requiring the Department of Public Health and Environment to recognize nationally accredited hospitals as ST Segment Elevation Myocardial Infarc-tion (STEMI) receiving/referring and primary/comprehensive stroke centers. This success will improve the efficiency of the system of care for victims of stroke and STEMI heart attacks and ultimately improve patient outcomes.

Advocates continued lobbying efforts by conducting a very successful Wear Red lobby day including a legislative break-fast. At the event, volunteers were given the chance to build key relationships with bill sponsors and other legislators. They promoted issues that pertain to the asso-ciation’s mission and laid the groundwork for more policy success in the future.

New MexicoAdvocates were successful in their campaign for a bill that allows the

Department of Health to recognize nationally accredited hospitals as ST Segment Elevation Myocardial Infarc-tion (STEMI) receiving/referring centers, helping more stroke patients receive care from qualified institutions.

Also, through a unanimous vote in both the House and Senate committees, the association garnered $250,000 in appropriations for the establishment of statewide stroke and heart attack regis-tries. This will allow for appropriate data collection to evaluate the delivery of care and patient outcomes. These two policies put the state in a place to greatly improve the system of care and reduce the burden of stroke and heart attacks.

OklahomaDuring this legislative session, advocates were successful in their efforts to enact a bill enacted a bill requiring the State Department of Health to promulgate rules to require pulse oximetry screen-ing on newborns prior to discharge from a birthing facility. This success was the result of various campaign efforts including several themed lobby days. One such lobby day included a meet-ing with the Insurance Commissioner

where advocates shared their collec-tive stories. Then in the spring, over 30 Sweethearts participated in the annual Sweethearts Day at the Capitol. The Sweetheart program is an association led program empowering high school girls to advocate for heart disease and stroke prevention priorities. The Sweethearts demonstrated how a pulse oximetry screening is administered. As a result, the Sweethearts received resolutions from their respective Senators, ultimately leading to the passage of the bill. This hard work will benefit many babies born across the state.

TexasThe association promoted several suc-cessful pieces of legislation during this session that will impact heart disease and stroke from many different angles. The state passed a bill requiring mandatory newborn screening for critical congeni-tal heart defects before discharge from the hospital. Then advocates achieved success with a bill mandating that all high school students complete training in CPR before they receive a diploma.

State Representative Donna Howard of Texas and other Lawmakers adopt a resolution for National Wear Red Day while volunteers are recognized on the dais.

SouthwestAffiliATE


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fOCus ON: acute events

Because the human body can survive for only a few minutes without oxygenated blood flowing to the brain and vital organs, cardiac events such as sudden cardiac arrest, heart attack and stroke are often the deadliest of emergencies. The key to survival is the immediate initiation of a series of events known as the Chain of Survival. The links in this chain are:

• Immediate recognition of cardiac arrest and activation of the emergency response system

• Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions

• Rapid defibrillation

• Effective advanced life support

• Integrated post-cardiac arrest care

The association works to support public policy initiatives across the country that promote increased quality and appropriate use of 911 systems; purchase and place automated external defibrillators (AED) for first responders and anticipated responders in high-risk locations; implement CPR training for high school students, lay rescuers and professional responders; and formalize training and certification in emergency medical dispatch to appropriately assess the needs of patients as well as provide life-saving pre-arrival instructions.

Working with health advocates across the nation, the association continued making significant strides in strengthening the Chain of Survival:

• The momentum behind assuring all students are trained in CPR prior to high school graduation continued to grow this year. Arkansas, Georgia, North Carolina, Rhode island, Texas, Virginia and Washington all enacted legislation assuring future generations will be trained in the life saving skill.

• In illinois the association aided in leading the Illinois EMS Alliance. This coalition championed several important bills to bring needed resources and smart reforms to the struggling Illinois EMS system.

• Advocates in hawaii worked with the State Depart-ment of Health and the State Department of Educa-tion to secure funding to purchase CPR manikins and training materials to facilitate CPR training in high school health classes.

• Advocates in Nebraska were successful in secur-ing an appropriation of $150,000 for 12-lead cardiac monitors to be used by rural EMS rescue services.

• Nevada made significant progress in improving and coordinating STEMI systems of care with the pas-sage of a bill that requires the state to recognize hospitals that have achieved accreditation as STEMI Receiving Centers.

• In New Jersey, Janet’s Law, named for 11 year old Janet Zilinski who died of cardiac arrest during cheerleading practice, passed both houses unani-mously and was signed by the governor. The law will require schools to have an automated external defi-brillator onsite during school hours and at all school sponsored sporting events. It also requires training for certain school personnel and development of a medical emergency response plan.

• North dakota saw the passage of an acute car-diovascular emergency bill that includes a STEMI registry and STEMI receiving facility designation and secured $450,000 to aid in assuring students are trained in CPR prior to high school graduation.

• Tennessee enacted legislation that requires health care providers to give instruction in infant CPR to at least one guardian of a newborn before discharge from the hospital. This simple additional proce-dure will equip countless parents with life-saving knowledge.

• The associa-tion was also able to secure $500,000 in the Texas state budget for the development of statewide stroke/STEMI data registries.

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Western StatesAffiliATE

AlaskaThe association succeeded in securing $1 million for the state’s Obesity Preven-tion and Control Program. This program will help families live healthier lives through school and community physical activity programs and improved access to healthy foods. At the local level, advocates successfully raised the tax on tobacco by $2.21 in the City of Bethel. This comes as a big win because evidence shows that increasing the price of tobacco products can significantly decrease their use, especially among youth.

The governor signed a law that ensures all newborns will receive a screening for critical congenital heart defects using pulse oximetry before they leave the hospital. This bill will have a significant impact on residents across the state, potentially helping them live longer, healthier lives.

ArizonaEarly in the session, the governor unex-pectedly prioritized increasing the reach of the Arizona Health Care Cost Contain-ment System (AHCCCS) by proposing to expand eligibility for childless adults

to 133% of the federal poverty level. The association, along with hundreds of other organizations, worked to garner support for the expansion. Both houses passed the bill, ensuring that an additional 300,000 people will be eligible for healthcare cov-erage through the state’s plan.

Advocates also prioritized a bill mak-ing CPR a graduation requirement for students. Under the bill, students would receive training at some point between 7th and 12th grade. During the hearing in the House Education Committee the bill was amended to be voluntary. While this is an important step toward ensuring that all students receive CPR training as a gradu-ation requirement, advocates will be back next session to encourage the legislature to make this requirement mandatory.

CaliforniaThanks to tireless advocacy efforts, thou-sands of emails in support, and touching stories shared, a bill requiring that hospi-tals screen newborns for critical congeni-tal heart defects (CCHD) was signed into law. By administering a pulse oximetry test to newborns before they leave the hospital, doctors can detect CCHD early and provide immediate care that will

reduce future heart complications and extend lives.

Advocates began moving a key tobacco tax bill forward, which proposes to raise the tax on tobacco by $2.00 to fund the state’s Tobacco Control Program and access to health care services. There is a broad coalition supporting the bill and the association looks forward to build-ing from this momentum into the next session.

HawaiiAdvocates worked with the State Depart-ment of Health and the State Department of Education to secure funding to pur-chase CPR manikins and training materi-als to implement CPR training in high school health classes. Association volun-teers then worked with teachers across the state to help position them to offer CPR instruction in their respective schools. These efforts support the establishment of a policy requiring all high school students to learn CPR prior to graduation.

Advocates also supported passage of a state legislative resolution that will help to improve cardiovascular health.


This will train students across the state with the ability to save a life wherever they go.

The association was also able to secure $500,000 in the state’s 2014-2015 budget bill for Stroke and ST Segment Elevation Myocardial Infarction (STEMI) data registries, increasing the pool of data for continued research aimed at improv-ing stroke care. In addition to this, advo-cates gained $4.5 million for the Lone Star Stroke Consortium. Together these

policies create a well-designed attack on heart disease and stroke.

WyomingAs the result of great efforts, the state passed a law that allows the Department of Health to recognize nationally accred-ited hospitals as ST Segment Elevation Myocardial Infarction (STEMI) receiv-ing/referring and primary/comprehensive stroke centers. This bill was the first piece of legislation that the association has

worked on and passed in the state since 2003. Additionally, advocates held the first lobby day in the state in four years. It was held to kick off National Wear Red Day in an effort to bring awareness to heart disease in women. Volunteers were able to meet with multiple bill sponsors that morning as well as other legislators to discuss the association’s legislative agenda. With this important policy victory and the strategic relationships formed, the association will continue to influence pol-icy throughout the state in a positive way.

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fOCus ON: access & quality of care

The burden of heart disease, stroke and other cardiovascular diseases (CVD) can be particularly problematic for those without health insurance or for those with inadequate coverage. The uninsured with CVD experience higher mortality rates and poorer blood pressure control. The uninsured and underin-sured are also less likely to take needed medications and to forego preventive care.

An AHA survey of CVD patients from January 2010 further demonstrates the challenges that many with heart disease or stroke face. More specifically the survey found that more than half of the patients surveyed had difficulties paying for medical care, even though most had insurance, and 46% of those who had difficulty paying their medical expenses said they had delayed getting needed care.

Many state legislatures and government agencies are looking toward disease management and insti-tuting quality improvement programs. The American Heart Association promotes public policy change to assist public entities in controlling health care costs while ensuring quality of care and patient safety. More specifically, the association is working to:

• Ensure that health coverage is universal, continuous and affordable both to individuals and society;

• Assure that efforts to expand access include cov-erage for appropriate care, treatment and preven-tion of heart disease and stroke;

• Promote public policies that ensure quality health care through adherence to evidence-based guide-lines and treatment protocols, including efforts to decrease disparities; and

• Work to create an environment in which the trans-lation of guidelines into practice can occur.

In working towards these goals, the association supported a number of initiatives at the state level, and saw incredible successes.

• With the hard work of dedicated advocates across the country, we have seen 15 states enact legisla-tion requiring every newborn be screened for criti-cal congenital heart defects using pulse oximetry, a non-invasive blood oxygen test, prior to leaving the hospital. Advocates in Alabama, Alaska, Arkansas, California, delaware, louisiana, Maryland, Minnesota, Nevada, North dakota, North Carolina, Oklahoma, Oregon, south dakota and utah successfully passed this poten-tially lifesaving legislation.

• Approximately 16 million adults with a history of cardiovascular disease and stroke receive their coverage through Medicaid. The American Heart Association supports full expansion of Medicaid up to 138 percent of the federal poverty level as authorized under the Affordable Care Act. If every state expands their Medicaid programs accord-ingly, access to vital health care services will be available to an additional 3.8 million uninsured Americans suffering from these diseases. By part-nering with broad-based healthcare coalitions we have been successful in seeing 24 states expand Medicaid.

By continuing to focus on and build up efforts surrounding access to care and quality of care, the association works to improve the health care system as a whole.

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The resolution established a State Stroke Task Force to focus on improving the state’s stroke system of care. The resolu-tion includes a request for the Task Force to establish a stroke database and reg-istry and consider using Get With The Guidelines®-Stroke as the means to col-lect and report data.

IdahoWith participation from all over the state, students joined the association for this year’s Youth Lobby Day. The day started with training where the association briefed students on issues such as physi-cal education in schools and funding for tobacco prevention. The association also hosted a legislative reception for the stu-dents, which nearly half of all the state’s legislators attended. Students educated elected officials on the selected issues and one student shared his story of los-ing nearly a hundred pounds thanks to his physical education teacher and the pro-gram at his school.

MontanaThe legislature approved a bill requiring insurance companies to provide coverage for telemedicine services. This ensures that rural residents will have better access to healthcare services, with the goal of working to improve statewide outcomes for acute cardiac and stroke events. Advo-cates were also successful in protecting funding levels for the state tobacco pro-gram and EMS services.

Advocates then worked with legislators to have a bill introduced that requires birthing centers to screen all newborns for critical congenital heart defects using pulse oximetry. Although the bill was ulti-mately unsuccessful, much was done to pave the way for future policy success.

NevadaNewborns across the state will have a better chance for a healthy start in life thanks to the passage of a bill requiring birthing

centers to screen all babies for criti-cal congenital heart disease using pulse oximetry prior to discharge from the hos-pital. A big step was also taken towards improving and coordinating ST Segment Elevated Myocardial Infarction (STEMI) systems of care with the passage of a bill that requires the state to recognize hos-pitals that have achieved accreditation as STEMI Receiving Centers.

The association also made prog-ress around the goal of assuring all students are trained in CPR. Legislation was enacted which requires middle or high school health classes to include CPR instruction based on psychomo-tor skills, if funding is available. Efforts are already underway to secure state funding so that all appropriate schools will have the capacity to implement the requirement.

OregonBabies will be given a healthy start to life with the passage of a pulse oximetry bill which will ensure that every baby is screened for critical congenital heart defects. The state’s students will also benefit from a $4 million appropriation that will be focused on providing physi-cal education grants to schools across the state. This funding will afford more children the opportunity to receive qual-ity and appropriate physical education throughout the day.

The legislature also invested an additional $4 million in tobacco

prevention. These resources will be used to protect residents from the insidious effects of tobacco and help current smok-ers quit. Advocates also established a statewide Stroke Registry and Stroke Care Committee to collect data and improve the outcomes of stroke patients.

Additionally, the legislature also expanded Medicaid coverage to those up to 138% of the federal poverty level, pro-viding coverage to an additional 180,000 people.

Utah On the second to last day of the session, the House and Senate voted to pass a bill requiring that birthing facilities screen all newborns for critical congenital heart defects by pulse oximetry. The associa-tion was part of a coalition that provided committee testimony and background information to make the case for this bill. Many advocates played an instrumental role in assuring this critical legislation was enacted into law.

WashingtonAdvocates lead a successful effort to improve sudden cardiac arrest survival rates by enacting legislation which will assure that all high school students receive training in CPR before graduation, prepar-ing future generations to save lives.

In 2005, voters passed the Clean Indoor Air law, prohibiting smoking in all indoor public places and workplaces.

Advocates successfully defended this critical law by fending off legislation that would have allowed cigar, pipe, and hookah smoking back inside 500 cigar shops and 100 lounges. The association and partner organiza-tions worked to ensure full implementation of the Affordable Care Act, successfully lobbying the legislature to sustainably fund the Health Benefit Exchange and expand Med-icaid, ensuring that more individuals have access to healthcare coverage.

Western States affiliate continued from page 19

Volunteers and staff with Governor Jay Inslee of Washington at the May 8, 2013 signing of HB 1556, the CPR in schools bill.

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We’re calling for change. Will you add your voice?A partnership was launched in February 2013 between the American Heart Association and the Robert Wood Johnson Foundation, Voices for Healthy Kids is a new advocacy initiative that aims to reverse the childhood obesity epidemic by 2015. Using the proven advocacy capacity of the American Heart Association, Voices for Healthy Kids will advance coordinated state and local public policy campaigns focused on preventing childhood obesity. Individuals in communities across the country will be engaged, organized and mobilized to create meaningful and widespread policy change.

The initiative is strategically designed to reverse the childhood obesity epidemic. First, Voices for Healthy Kids will collaborate with movement leaders through relationships with individuals and organizations that are experts in the childhood obesity epidemic. Second, the initiative will develop comprehensive campaign plans based on six key policy areas. Finally, Voices for Healthy Kids will strategically provide resources to propel campaigns with strong potential for success.

Target AreasVoices for Healthy Kids will pursue six policy targets that research and practice suggest will have the

greatest impact. These policy targets include: improving the nutritional quality of snack foods and beverages in schools; reducing consumption of sugary beverages; protecting children from unhealthy food and beverage marketing; increasing access to affordable healthy foods; increasing access to parks, playgrounds, walking paths, bike lanes and other opportunities to be physically active; and helping schools and youth-serving programs increase children’s physical activity levels.

While childhood obesity affects the entire country, it does not affect all communities equally. For this reason, Voices for Healthy Kids is committed to reaching communities that are disproportionately affected by the epidemic. These communities include high poverty urban populations, particularly African-Americans and Latinos, as well as high poverty rural populations of all races and ethnicity, including Native Americans.

Expert PartnersVoices for Healthy Kids is leveraging a team of experts to support each of the six policy targets. Organizations that will support the success of state and local campaigns include Safe Routes to School National Partnership, The Food Trust, YMCA of the USA, The Pew Charitable Trusts, Yale Rudd Center for Food Policy & Obesity, and Berkeley Media Studies Group. Each has an existing national

fOCus ON: Voices for healthy Kids

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network and significant experience in public policy change on both the local and state levels. These organizations will provide technical assistance on campaigns and strengthen national coalitions to further impact policy change.

This work will unite the voices of moms, dads, sisters and brothers in communities across America. The changes demanded by these voices will be backed by the best science and amplified by the leadership and resources of the American Heart Association and the Robert Wood Johnson Foundation, as well as the expertise and skills of a vast coalition of our nation’s leading advocacy organizations. To succeed, we need involvement at every level, from partnerships with national organizations and grassroots groups to individual participation.

Become one of the Voices for Healthy Kids. Learn more and join in at www.voicesforhealthykids.org.

American Heart AssociationNational Center7272 Greenville AvenueDallas, TX 75231www.yourethecure.org

The Advocacy Pulse Legislative Wrap-Up is an annual update from the Advocacy Department of the American Heart Association. Please contact the Advocacy Department with any questions at (202) 785-7900, or visit www.yourethecure.org.

This year we have seen victories on issues like CPR in schools, childhood obesity, protecting clean indoor air and providing care for heart and stroke patients. You’re the Cure advocates create change in their neighborhoods by having their voices heard by their local, state and federal decision makers.

So, are you asking yourself “How do I join a community of advocates who urge their officials to support stroke smart and heart healthy policies in their communities?” It’s easy. Just go to www.yourethecure.org and sign-up today! By signing up, we will connect you with many activities that can make a real difference in your local community and nationwide, including:

1. Making your voice heard on the most current policy issues in real-time with our online action alerts.

2. Information for local AHA advocacy events.

3. Opportunities to meet face-to-face with local and federal lawmakers.

4. sharing your story with lawmakers and other You’re the Cure advocates.

Whether it is emailing your lawmakers or meeting with them face-to-face, your voice is crucial in our shared fight against heart disease and stroke. Go to www.yourethecure.org and sign-up today.

Be a hero — Join You’re the Cure Today!

Documents

Advocacy Pulse - heart.orgwcm/@adv/documents/downloadable/... · Advocacy Pulse Above photo: Washington advocates and staff at the capitol in Olympia, lobbying for CPR in schools