The Role of Legislation in Legitimizing Public Health Efforts

In 2003, the California State Legislature passed a law that mandates the appointment of a 12-member Task Force to write a state master plan for heart disease and stroke prevention and treatment. Under the law, the task force was to include: one cardiologist, one neurologist, a member of a voluntary health agency, one member representing a population disparately affected by heart disease or stroke, a one stroke victim, one heart disease victim, a hospital administrator, a representative from a health care organization, a registered dietician, a registered nurse, a local public health representative, a university-affiliated heart disease or stroke expert. Half of the members were to be appointed by the Legislature; the other half were to be appointed by the Governor. The Task Force was charged with completing the plan by November 1, 2005.

The California Heart Disease and Stroke Prevention (CHDSP) Program hoped that the passage of AB 1220 would legitimize its efforts to frame a state heart disease and stroke plan. The theory was that once the Legislature had underscored the importance of the fight against heart disease and stroke by adopting this measure, it would be easier for the CHDSP to raise funds from private sources to fund the operation of the Task Force. The theory proved true.

CHDSP also hoped that the law would help to rally stakeholders in the fight against heart disease and stroke. To structure that “rally,” CHDSP staff held public forums in seven regions of the state. Each forum featured a panel of experts who offered recommendations about what the proposed master plan should contain. Panel members were identified by a local planning committee convened by CHDSP. The proceedings of the forums were recorded and summarized in a report for the Task Force. In addition there were two very important collateral benefits of the forums:

· The forums provided a venue for stakeholders in the various communities to come together (sometimes for the first time) to recognize important opportunities for collaboration. To encourage this, CHDSP included a list of local stakeholders with contact information in materials that were distributed to forum panelists and public attendees.

· The forums contributed to the development of a statewide infrastructure that will be critical to the implementation of the master plan once it is framed. We now have a database of individuals, institutions and community-based organizations who are passionate about the control and prevention of heart disease and stroke and are willing to address those parts of the state plan that are consistent with their missions.

The law establishing the Task Force went into effect on January 2004. Task Force members were to be appointed by April 2004, and the master plan was to have been completed by November 2005. However, due to a proposed reorganization of California government, as of April 2005, only half of the 12 members had been appointed. The remainder of the members were appointed by August 2005, and the Task Force began to meet in October 2005. A final draft of the master plan is expected in June 2006.

Policy Initiation

In California, as elsewhere, heart disease and stroke are the first and third leading causes of death. As late as 2003, the state lacked a plan to coordinate the efforts of the many stakeholders interested in addressing this problem. Obstacles to the creation of a plan were lack of funds and low awareness of the burden of heart disease on the part of policymakers. To address both these problems, the California Heart Disease and Stroke Prevention (CHDSP) Program in collaboration with the American Heart Association and the California Elected Women’s Association sponsored a Heart Disease Information Day for legislators. Speakers included epidemiologists who used data to profile the heart disease and stroke burden, clinicians who used research findings to illuminate gaps in knowledge, and heart attack survivors who used their own stories to convey the personal toll taken by heart disease. As a direct result of this Day, a bill (AB 1220) was introduced to establish a Task Force to write the state plan. Grassroots efforts on the part of the American Heart Association (as well as a clause in the bill that stated the costs associated with the operation of the Task Force had to come from non-state sources) assured the passage of the bill.

Public Health Agency Roles

The Health Department’s California Heart Disease and Stroke Prevention (CHDSP) Program:

· Sponsored the Heart Disease Information Day for legislators

· Raised money from private sources to support the work of the Task Force charged with writing the state plan

· Planned and held seven regional forums that provided recommendations regarding content of the proposed state plan

· Prepared a report summarizing the proceedings of the seven public forums

Major Partners

In addition to the CHDSP support, the following were major partners in this initiative:

· Funders: Kaiser Permanente, AstraZeneca, American Heart Association

· Advocates: American Heart Association

· Forum planning committee members and panelists who included representatives from the Hospital Council, Lumetra (State QIO), local public health departments, local heart disease coalitions, hospitals, health plans, and disparately served populations, as well as land use planners, school nurses, and heart disease and stroke survivors.

Official Support

The bill was carried by Assembly member Patty Berg (D). The California Legislature demonstrated its support by passing the bill and making appointments in a timely manner,

Results from the Policy

Once the master plan is written CHDSP will track how it is being implemented (the process) as well as the outcomes. CHDSP will develop a formal evaluation plan.

Lessons Learned

We learned that attempting to change policy is an unpredictable process and that flexibility in the face of change is essential.

We also learned through the forum process that there are many stakeholders in heart disease and stroke who are not particularly visible until you reach into the local community. These local organizations often prove to be the most effective and energetic partners.

Opposition

There was no opposition to this initiative.

Submitted By

Nan Pheatt, MPH

Secondary Prevention and Professional Education Manager

California Heart Disease and Stroke Prevention Program

California Department of Health Services

P.O. Box 997413 MS 7212

Sacramento, CA 95899

(916) 552-9953

(916) 552-9911 FAX

npheatt@dhs.ca.gov