advocacy pulse 2015 - heart.orgwcm/@global/...congenital heart defects, meaning nearly 900,000 more...

LEGISLATIVE WRAP-UP

Advocacy Pulse

2015

2015 LEGISL ATIVE WRAP-UPYOU'RE THE CURE

AMERICAN HEART ASSOCIATION | AMERICAN STROKE ASSOCIATION 2

MY FELLOW ADVOCATES,

It’s my pleasure to present the American Heart Association’s annual report of state and local public policy progress. As Executive Vice President for Advocacy and Quality, I take pride in the diligent efforts of our advocates, volunteers and staff to improve the cardiovascular health of all Americans.

As we review 2014-15, we can take great pride in our advocacy presence in all 50 state capitols, the District of Columbia and communities across the country.

Our efforts have led to the passage of nearly 70 state or local laws or regulations. These victories have significant impact on Americans across the country, helping us all enjoy longer, healthier lives, free of cardiovascular diseases and stroke:

On behalf of the thousands of You’re the Cure advocates, volunteers, donors and staff, I’m proud to present this annual report of state and local advocacy accomplishments. Together, we’re building healthier lives, free of cardiovascular diseases and stroke.

Sincerely,

Mark Schoeberl Executive Vice President Advocacy & Health Quality

American Heart Association/American Stroke Association

• Philadelphia raised the tax on cigarettes by $2 per pack, the largest increase ever. Three more states also increased their cigarette taxes.

• Berkeley, California became the first city in the United States to impose a penny-per-ounce tax on soda and other sugar-sweetened beverages.

• New Orleans banned smoking in most indoor public places, including bars, restaurants and casinos.

• The District of Columbia required foods and beverages sold through vending machines, cafeterias and concessions by the government to meet healthy standards.

• Eleven states and the District of Columbia enacted policies that will strengthen their systems of care for stroke and STEMI patients.

• Four states expanded their Medicaid program, providing access to health insurance coverage for more than 1 million people.

• Nine states passed measures to screen infants for congenital heart defects, meaning nearly 900,000 more babies will be screened each year. The simple, inexpensive, lifesaving pulse oximetry test is now required in 41 states.

• Six states passed policies to train students in CPR. Now more than 1.3 million students in 24 states will graduate from high school with lifesaving CPR skills.

• Five states and the District of Columbia moved to develop or enhance registries for stroke and STEMI patients.

• Five states passed policies that align with the new federal standards for school nutrition. Now more than 4.7 million kids will get healthier foods at school.

• Three states passed shared-use liability laws. Now more than 16 million people have better access to safe places to exercise.

• Two states secured significant funding to make it easier for people to walk and ride bicycles to schools and across their communities.

• Two states made significant increases in funding for tobacco prevention and control programs.



ALABAMA

• Advocates and staff helped advance and pass the Healthy Food Financing Initiative bill to bring healthy grocery stores into neighborhoods.

• We worked closely with the governor and legislature to promote a tobacco tax to help provide needed revenue to the cash-strapped general fund. We advocated for Medicaid expansion and partnered with others to support a comprehensive smoke-free policy in Montgomery.

• We worked closely with the State School Board as well as Department of Education to work towards the promotion of healthy eating behaviors through adoption of the USDA Smart Snacks in School nutrition standards.

• Advocates and legislators partnered to bring Sugary Sweet Beverage tax to the forefront of conversations when discussing the upcoming budget crisis.

ALASKA

• We were successful in expanding Medicaid, providing 40,000 Alaskans health coverage. Besides the public health impact, Medicaid expansion will save the state about $6.1 million in medical costs in 2016.

• Volunteer advocates worked diligently to preserve funding for the State Tobacco Control and Prevention Program and were instrumental in protecting the remaining $400,000 in state appropriations for childhood obesity prevention.

• We provided key testimony to move a comprehensive smoke-free legislation bill out of the first committee, where we faced significant opposition. Working with coalition partners, advocates galvanized support in the community, with thousands of supporter cards signed and delivered to the legislature.

• We supported a bill that makes automated external defibrillators more accessible to the public.

ARIZONA

• Advocates focused on expanding the Stroke Center Designation regulations to include Acute Stroke Ready Hospitals and Comprehensive Stroke Centers. The House and Senate unanimously supported the Stroke Center legislation, which Governor Ducey signed into law in March.

• We advocated for legislation to require Hands-Only CPR training in middle schools. Though the Hands-Only CPR bill didn’t pass, a legislator who nearly lost his wife to Sudden Cardiac Arrest will sponsor the bill during the 2015-16 session.

Wrap-up by state

STATE SUCCESS STORIES

FOCUS ON...

Alabama ...........................3Alaska ..............................3Arizona .............................3Arkansas ..........................6California .........................6Colorado ..........................6Connecticut .....................6Delaware ..........................6District of Columbia ........6Florida ..............................8Georgia ............................9Hawaii ..............................9Idaho ................................9

Illinois .............................10Indiana ...........................10Iowa ...............................10Kansas ...........................10Kentucky ........................10Louisiana .................10, 12Maine .............................12Maryland ........................12Massachusetts ..............12Michigan ........................12Minnesota ......................12Mississippi .....................13Missouri .........................13

Montana .........................13Nebraska .......................13Nevada ...........................13New Hampshire .............14New Jersey ....................14New Mexico ...................14New York.................. 14-15North Carolina ...............15North Dakota .................15Ohio ................................15Oklahoma ......................16Oregon ...........................16Pennsylvania .................16

Rhode Island ........... 16-17South Carolina ......... 17-18South Dakota ................18Tennessee ......................18Texas ..............................18Utah................................19Vermont .........................19Virginia ...........................19Washington.............. 19-20West Virginia..................20Wisconsin ......................20Wyoming .......................20

Voices for Healthy Kids ....................................................4-5 Stopping Tobacco ............................................................... 7Helping People Eat Healthy ................................................ 8Saving Lives with CPR ........................................................ 9ANCHOR ............................................................................ 11

Helping American Get Moving ......................................... 14Improving Public Health ................................................... 17Protecting Babies from Heart Defects ............................ 18Improving Quality Care ..................................................... 19


4AMERICAN HEART ASSOCIATION | AMERICAN STROKE ASSOCIATION

Voices for Healthy Kids® — a joint initiative of the Robert Wood Johnson Foundation and American Heart Association — is transforming the health of our nation’s children.

In its first two years, Voices for Healthy Kids has invested in 59 state and community policy campaigns and provided technical support to many others to reverse the childhood obesity epidemic and build a culture of health in the United States. Nearly one in eight Americans are being affected by our progress thus far — reaching communities most impacted by childhood obesity.

HIGHLIGHTS FROM THE SECOND YEAR:• Public policy advances across the country in 2014

and 2015 affect nearly 36 million Americans, many of whom living in communities with more than 30 percent minority or low-income populations.

• These wins positively impact states and cities with high rates of overweight and obese children, including:

▪ Arizona, Iowa, Ohio and West Virginia passed share use policies, opening more school playgrounds and gyms to the public.

▪ Washington State secured $15.3 million for walking and biking infrastructure and $6.75 million for Safe Routes to School funding. The Washington Legislature appropriated $5 million in new funding for Governor Inslee’s Healthy Kids – Healthy Schools grant program. Districts may apply for up to $200,000 in grants to fund infrastructure projects that help increase physical activity and access to healthy food. Up to $1 million of the appropriation is designated to purchase and install water bottle filling stations.



▪ The East Baton Rouge Metro Council unanimously adopted a complete streets policy that creates two committees — one to design and adopt the technical specifications to implement complete streets, the other to ensure community input into how the policy is implemented.

▪ Massachusetts secured $12.5 million for the newly created Complete Streets Certification program.

▪ The Alabama Legislature enacted the “Alabama Healthy Food Financing Act,” which begins to build a much needed infrastructure to help bring healthy food closer to home for more than a million Alabamians by creating a statewide healthy food financing initiative.

▪ Florida, New Mexico, Nevada, Utah and Oregon passed policies that ensure their schools have resources and technical assistance to implement federal school nutrition policies.

▪ Nevada became the first state to adopt a new and robust school wellness policy that limits the marketing of foods and beverages on school campuses to products that meet the Smart Snacks nutrition standards.

Voices for Healthy Kids is not just leading advocates, but teaching advocates to be leaders within their communities and states. To date, our annual grantee meeting and eleven Regional Advocacy Orientations have trained more than 600 advocates.

Through PreventObesity.net, we’re building a national online network to power the movement to prevent childhood obesity. PreventObesity.net offers tools, services and support to people and organizations working to ensure children everywhere eat healthier and be more physically active. Join today by visiting PreventObesity.net.

Voices for Healthy Kids includes leading national organizations dedicated to policy change that helps kids achieve a healthy weight. More than 20 of these organizations make up our Strategic Advisory Committee, which advances

coordinated advocacy campaigns focused on childhood obesity policy. Groups include the American Cancer Society Cancer Action Network, Center for Science in the Public Interest, Alliance for a Healthier Generation, MomsRising, NAACP, National Council of La Raza, Rudd Center for Food Policy and Obesity, Safe Routes to Schools National Partnership, Salud! America, The American Academy of Pediatrics, The Food Trust, The Notah Begay III Foundation, The Pew Charitable Trusts and the YMCA of the USA.

©2015 American Heart Association.



ARKANSAS

• Our support of a bill that would adopt state level recognition of stroke facilities laid a solid foundation to revisit the issue in future legislative sessions.

• Staff and volunteers worked with community partners to establish smoke-free coalitions in Little Rock and Fayetteville.

• The Arkansas State Government Relations team developed multiple Advocacy After Hours events across the state to promote the AHA’s policy agenda and engage lawmakers and volunteers.

CALIFORNIA

• Berkeley became the first city in the country to pass a penny-per-ounce SSB tax, allocating revenues to health education and nutrition.

• We made progress on a bill that would place a 2-cent health impact fee on SSBs. Despite heavy opposition from the beverage industry, we secured an author and built a coalition to continue our work next year.

• San Francisco Unified School District became the first major metropolitan school district in the country to require hands-on CPR training for graduation.

• We built momentum for CPR in schools legislation, moving the bill out of a challenging committee and gaining powerful co-authors.

• We worked to hard to pass a comprehensive cessation coverage bill.

• Advocates focused on getting e-cigarettes regulated and defeated two anti-tobacco control bills.

COLORADO

• Lawmakers and advocates came together to support legislation that ensures babies born in Colorado will have a pulse oximetry test prior to leaving the hospital. AHA volunteer Gretchen Whitehurst moved lawmakers with her account of how this critical test caught her son’s critical congenital heart defect hours after birth.

• On Feb. 6, women across the state celebrated a resolution declaring Colorado’s formal recognition of National Wear Red Day.

CONNECTICUT

• Volunteers and staff successfully advocated for legislation to require CPR training for graduation, making Connecticut the 24th state to pass this lifesaving policy.

• We influenced an increase in excise tax on a pack of cigarettes by 50 cents over the next two years — the second highest in the country.

• Our Stroke Task Force began crafting recommendations to improve stroke systems of care by implementing a tiered system of stroke facility designation and a statewide stroke registry.

DELAWARE

• Volunteers and staff successfully advocated for CPR training as a requirement in high schools and state funding for the trainings.

• Advocates battled valiantly to ban the use of e-cigarettes indoors and to add these new tobacco products to the state’s landmark comprehensive Clean Indoor Air Act. After beating back most of the amendments that would have weakened and compromised the public health

protections of the law, the governor signed the bill a few days after the legislative session ended.

• Delaware continued its meteoric rise in the Bike Friendly States rankings, moving from No. 4 to No. 3 after being in the 30’s a few years ago. This is due to unparalleled appropriations and Bike Delaware’s partnership with the American Heart Association.

DISTRICT OF COLUMBIA

• Advocates and volunteers successfully advocated for the Healthy Hearts of Babies Act, which ensures that newborns in Washington, D.C. will be screened for critical congenital heart disease with pulse oximetry prior to discharge from the hospital.

• Advocates helped fully restore $3.2 million to implement the Healthy Tots Act, which establishes nutrition standards in childcare facilities.

• We were instrumental in defending tobacco control dollars that had been cut out of the budget. After hearing advocates’ stories and messages, the D.C. Council appropriated $1.36 million to support the tobacco quitline. Washington, D.C. became one of the few jurisdictions to tax electronic cigarettes.

• Advocates and volunteers continue to work toward advancing a Shared Use Incentives policy to ensure that citizens have access to local institutions to stay physically active.

• Advocates worked to secure a procurement policy that covers all vending machines and service on D.C. property.



Stopping TobaccoPROBLEM:

Tobacco is the leading controllable risk factor for cardiovascular diseases and stroke in this country. Smoking or secondhand smoke cause about 480,000 deaths a year in the United States. About 35 percent of all tobacco deaths are related to cardiovascular diseases and stroke.

SOLUTIONS:

Smoke-Free Air PoliciesNonsmokers exposed to secondhand smoke at home or work face 25-30 percent higher risks for heart disease and 25-30 percent higher risks for lung cancer, according to the U.S. Surgeon General. That’s why the association advocates for comprehensive smoke-free workplace laws at the state and local levels. Thanks to the work of advocates across the country, about half of Americans now live in communities that keep smoke out of all workplaces, restaurants and bars. And it’s paying off. Seventeen percent fewer heart attacks occurred in communities after such laws had been in place for a year, according to a report in Circulation: Journal of the American Heart Association.

Tobacco Excise TaxesTaxes are one of the most effective ways to reduce tobacco use, especially among kids. Every 10 percent increase in cigarette prices has reduced youth smoking by about 7 percent and total cigarette consumption by about 4 percent, according to the Campaign for Tobacco-Free Kids. The association’s support of these taxes is producing impressive results. In every state that has significantly raised its cigarette tax rate, pack sales have decreased sharply. The average state tax is $1.60 a pack, up from 42 cents in 2000. States can realize even greater health benefits and cost savings by allocating revenue to programs that prevent children from smoking and help smokers quit.

Funding Tobacco Prevention and ControlCombining tax increases with statewide tobacco prevention campaigns reduces tobacco use — and saves lives. Advocates worked hard to make sure state budgets include substantial funds for prevention programs. These efforts prevent kids from smoking, help smokers quit, protect people from secondhand smoke and reduce tobacco-related healthcare costs.

Helping Smokers Become QuittersDespite the efforts of the AHA and our partners in tobacco prevention, 20.5 percent of men and 15.8 percent of women in the United States still smoke. To help save these lives, the association advocates for insurance to cover medications, counseling and other tools that help people quit.



FLORIDA

• Volunteers and advocates continued their multi-year campaign to pass legislation requiring CPR for high school graduation. While this lifesaving legislation continues to confront political roadblocks at the state level, we are taking the fight to the local level in Florida next year.

• Advocates began efforts to establish and program and secure funding for Healthy Food Financing which will bring grocery stores closer to people.

• Volunteers and staff worked closely with partner organizations to support expanding Medicaid, which would provide healthcare coverage for nearly 1 million Floridians.

• Volunteers in Florida generated hundreds of letters, participated in media interviews and attended workshops in support of adopting a more restrictive smart snack policy in Florida. Their effort was successful and Florida was one of the first states to comply with the new federal competitive food standards.

Helping People Eat HealthyPROBLEM:

Nearly one in three kids and teens are overweight or obese. Adults and children are eating too many foods high in saturated and trans fats, cholesterol, added sugars, salt and refined grains. They’re eating more food away from home, where portion sizes are larger and calories are higher. Following healthy eating patterns — like those the American Heart Association recommends — is one of the best, easiest and smartest ways people can keep their hearts healthy. Even small changes can result in long-term benefits.

SOLUTIONS:

Voices for Healthy KidsVoices for Healthy Kids engages, organizes and mobilizes people to improve the health of their communities by helping children achieve a healthy weight. The inaugural year of the collaboration between the American Heart Association and the Robert Wood Johnson Foundation set the stage for a transformation of the health of our nation’s children. We’ve put a plan in motion to accomplish sweeping policy change to help all Americans live longer and healthier for generations to come.

Voices for Healthy Kids is working to shape healthy environments across geographic, demographic and social sectors, ensuring all children, especially those in underserved and at-risk communities, are living, learning and playing healthfully. Voices for Healthy Kids focuses on key issue areas, including:

• Eliminating food deserts and improving access and affordability of healthy foods.• Strengthening nutrition standards in schools.• Creating healthier environments in child care facilities.• Increasing access to healthier options on public property.• Improving children’s restaurant meals.



GEORGIA

• Volunteers and advocates worked before, during and after the legislative session to increase the state tobacco tax to the national average. Despite bringing in nearly $600 million in new revenue, the state opted to table the tax for the summer and winter study committee process. The state is operating in the black, but needed additional revenue for ailing transportation problems.

• Advocates continued to implement campaigns to pass comprehensive smoke-free ordinances in efforts in Augusta and Columbus, the state’s second and third largest cities.

• Working closely with key volunteers and tobacco control partners we were able to ensure all adult Medicaid recipients will receive tobacco cessation coverage, which means many of our citizens with the most challenging health circumstances will have the support to quit using tobacco products.

• Analyzing current school nutrition policies within the Departments of Education, Public Health and Agriculture against the Voices for Healthy Kids policy bottom lines for Smart Snacks.

HAWAII

• Volunteers, staff and community partners successfully advocated for a bill that requires birthing centers to screen newborns for critical congenital heart defects using pulse oximetry test prior to discharge.

• We successfully passed a bill that establishes a state stroke registry and requires acute stroke care hospitals to collect and submit stroke data to the State Department of Health.

• Advocates celebrated Hawaii becoming the first state to enact a bill that raises the legal age to purchase and possess tobacco products to 21. The legislature further protected Hawaii residents from the dangers of tobacco by restricting electronic smoking devices in the same places where smoking is banned.

• Advocates successfully fought to protect the state’s Tobacco Prevention and Control Trust Fund and helped secure a 6 percent increase in allocations.

IDAHO

• Volunteers and advocates secured more than $4.7 million for a wide range of tobacco prevention and cessation projects — the highest amount ever funded in Idaho and 25 percent of the CDC recommended level.

• We influenced the establishment of the Time Sensitive Emergencies Council that began implementing a state wide system of care for stroke and STEMI patients.

• We continued talks with legislators about improving heart health through school-based physical education programs and healthy snacks.

• We joined the Steering Committee for the state coalition to collaborate on new legislative strategies that will ensure Medicad expansion.

• We began working with Let’s Move Boise to create mobile farmers markets for food desserts and procurement for the city.

Saving Lives with CPRPROBLEM:

Only 10 percent of 325,000 people survive cardiac arrest outside of a hospital every year — most likely because they don’t receive timely CPR. Sudden cardiac arrest can happen in any place, at any time. When given right away, CPR doubles or triples survival rates.

SOLUTIONS:

CPR in SchoolsTeaching students CPR can save thousands of lives, which is why the AHA advocates for state laws requiring CPR as a graduation requirement. Thanks to efforts by the AHA and our partners to get such laws passed, more than 1.3 million high school students will be trained in CPR every year.



ILLINOIS

• Advocates and volunteers encouraged passage of stroke legislation that will improve care for stroke patients.

• Volunteers and staff teamed up with smoke-free advocates to help restore funds for Tobacco Quit Line.

• We supported the Illinois Smoke Free Campus Act that made college and university campuses smoke free.

• Advocates are working closely with the Illinois State Board of Education to help high schools implement CPR and AED training for students prior to graduation.

INDIANA

• Staff and volunteers partnered with hospitals, patient advocates and other stakeholders to create HIP 2.0, a program that will provide health insurance coverage to an estimated 350,000 low income adults and hypertension treatment to about 18,000 people.

• The legislature passed a bill requiring all high school students to learn CPR prior to graduation.

• Through sponsorships, local county foundations, private estate funds and a significant contribution from the Midwest Affiliate Board, the AHA placed CPR in Schools kits in the nine Education Resource Centers in the state. After placement of the kits, the Indiana State Department of Education agreed to allow a waiver for schools unable to provide the skills portion of the training to expire June 30. Now all schools are required to provide Hands-Only CPR training.

IOWA

• We started 2015 with the passage of the CCHD screening legislation. Now, more than 39,000 Iowa babies will get a pulse oximetry test as part of their newborn screenings at all hospitals.

• Governor Branstad signed our community use bill into law.

• In a time of budget cuts, we secured level funding for the Tobacco Use Prevention and Control program.

KANSAS

• After significant lobbying by the AHA and our partners, Kansas raised its cigarette tax by 50 cents to $1.29 per pack. AHA board members and You’re the Cure volunteers testified before the House and Senate taxation committees and met with lawmakers during community meetings.

• Advocates were also successful in securing a 20-cent-per-milliliter tax on the liquids used in electronic cigarettes.

KENTUCKY

• Volunteers and staff successfully advocated for the passage of a bill that will improve the quality of care for nearly 15,000 stroke patients by ensuring they’re transported and treated at the most the most appropriate stroke facilities.

• In its fifth year, Smoke Free KY passed as an amended bill in the House, but met insurmountable opposition in the Senate.

• For the second consecutive year, the House unanimously passed Kentucky’s CPR in High Schools bill, but it stalled in the Senate.

LOUISIANA

• New Orleans passed a smoke-free workplace law that includes bars and casinos. As a result of the comprehensive policy, more than 5,000 employees are protected from secondhand smoke in bars and casinos.

• The state increased the tobacco tax by 50 cents.

Volunteers and staff celebrating the signing of smoke-free New Orleans.



ANCHOR: Accelerating National Community Health Outcomes through Reinforcing Partnerships ProgramThe American Heart Association’s ANCHOR Program promotes healthy communities, prevents chronic diseases and reduces health disparities. Funded by the Centers for Disease Control, ANCHOR projects are in 15 communities across the United States working to:

• Protect people from secondhand smoke through smoke-free environment initiatives.

• Improve access to healthy foods where people live, learn, work and play.

• Encourage increased physical activity through shared use agreements and physical education in schools.

CLEARING THE AIR

ANCHOR is increasing access to indoor and outdoor smoke-free environments by facilitating education and outreach opportunities. Local activities include grassroots messaging, local events and presentations on smoke-free environments. ANCHOR protects people from the dangers of secondhand smoke at parks, beaches, trails, college campuses, casinos, bars and restaurants.

HELPING PEOPLE EAT HEALTHY

ANCHOR has a multi-prong approach to make healthy eating easier and more affordable. Efforts include:

• Procurement initiatives to increase availability of healthy foods and beverages in workplaces, government facilities, hospitals and early care and education settings.

• Projects that increase access to healthy foods and beverages in food insecure areas.

• Campaigns aimed at making farmers markets more accessible and affordable for all people, especially those living in underserved communities or within food deserts.

GETTING PEOPLE ACTIVE

ANCHOR helps people get moving by increasing access to physical activities in schools and communities. Local activities include partnering with school board leaders, principals, teachers, physical education staff and parents to increase activity levels and help students reach the AHA’s recommended 60 minutes of daily moderate to vigorous physical activity. Efforts are also focused on getting people of all ages active by supporting shared use agreements that allow access to schools before, during and after school.

For more information about ANCHOR, please visit heart.org/ANCHOR.



• The state enacted standards for the formal recognition of stroke and STEMI facility development of EMS transport protocols. Our success is due to building sustainable grassroot coalitions, educating and recruiting key legislative partners and increasing awareness through media advocacy.

• Advocates made significant advances in getting funding for the Healthy Food Financing Fund by securing $400K in the state’s legislative budget that was ultimately removed by the Governor. With significant gains in the legislature advocates will work with the new Governor in 2016 to support food access efforts.

MAINE

• Volunteers and advocates overcame efforts to severely cut the Fund for a Healthy Maine. In particular, we fought the elimination of local tobacco and obesity coalitions and decimation of the state’s tobacco program.

• We were integral to the passage of a bill that requires high schools in Maine to offer Hands-OnCPR trainings to students.

• We fought back the re-introduction of cigar bars in Maine and successfully advocated for legislation that prohibits e-cigarette use in public places where smoking is banned.

MARYLAND

• The Maryland General Assembly passed legislation that prohibits selling e-cigarettes and distributing e-cigarettes or anything used to refill or resupply the device to minors.

• We supported a bill which will require the Office of Minority Health to organize, promote and deliver courses in cultural and linguistic competency, health disparities and health literacy.

• Volunteers successfully advocated for a Healthy Food Financing Initiative that will provide a property tax credit for supermarkets in Baltimore that complete specified construction in a food desert and sells healthy foods.

MASSACHUSETTS

• We worked with our partners to urge the legislature to establish the Massachusetts Food Trust Program. The program would provide loans, grants and technical assistance for new and expanded healthy food retailers and food enterprises in low and moderate income communities.

• Through a Transportation Bond Bill, we helped ensure that our cities and towns include language on complete streets in order to support the design and construction of roadways that accommodate all users and modes of transportation. We were then able to secure $12.5 million in 2015 to fund the Complete Streets Certification Program.

• We advocated for fresh food financing in an Environment Bond Bill.

• Due to the efforts of advocates and staff, coaches in public schools are now required to be certified in CPR.

• We worked with four schools that now require CPR to graduate, resulting in more than 1,000 students getting trained in CPR.

MICHIGAN

• We built significant momentum for healthy food access and CPR as a graduation requirement.

• We introduced 55 new lawmakers to AHA issues and held a Go Red at the Capitol event, during which many lawmakers shared their reasons for going Red.

• We successfully fought attempts to eliminate funding for state prevention programs, including heart disease, stroke, physical activity and nutrition.

• Lawmakers passed a county regulation prohibiting e-cigarettes in public places — the first law of its kind in the state.

• We supported efforts to ensure continued funding of the statewide trauma system by advocating for passage of an extension to the law.

MINNESOTA

• We strengthened the state’s stroke system by requiring EMS stroke protocols for ambulance services and securing funding to ensure that the Minnesota Stroke System can continue for years.

• We defended the $35 million for Minnesota’s obesity and tobacco prevention fund against proposed elimination.

• We helped secure $250,000 per year to better report health data on race, ethnicity and language to close gaps in health disparities.

• We successfully ensured that all Medicaid enrollees in the state have access to preventive services.

• We conducted our first Minnesotans for Healthy Kids Coalition Lobby Day, mobilizing thousands of advocates.



MISSISSIPPI

• The Mississippi State Board of Health voted to add the pulse oximetry test for critical congenital heart defects to the newborn screening panel.

• We partnered with the Mississippi Healthcare Alliance to secure $500,000 in new appropriations for systems of care in Mississippi by reviewing and collecting non personal information about patients, which will allow hospitals and care systems to improve care and patient outcomes.

• Advocates worked to pass comprehensive smoke free ordinances in 13 municipalities during the 2014-2015 fiscal year. This brought Mississippi to a total of 104 comprehensive smoke free ordinances which covers 30.19% of the state's population.

MISSOURI

• We made great progress in our efforts to require CPR for graduation.

• Volunteers successfully protected $500,000 in funding for the Show Me Healthy Women Program that helps underinsured and low income women obtain lifesaving screenings.

• The state allocated $100,000 for tobacco prevention programs — an increase from previous years.

• Volunteers met with legislators to educate them on the importance of the Million Hearts program and Go Red For Women.

• We secured a $150,000 two-year grant from the Missouri Foundation for Health to assist us with our policy priorities for the next two years. Because of the funding, we educated voters through print and media advertisements that eventually helped us enact smoke-free air laws in Clinton and Branson.

MONTANA

• Advocates and volunteers successfully lobbied for passage of the Health and Economic Livelihood Partnership Act (HELP). The legislation will expand Medicaid in Montana through a waiver program, covering an additional 40,000 residents.

• Advocates supported a bill that blocks minors from purchasing e-cigarette products.

• In a continued battle for smoke-free air, staff and partners have closely followed the Montana Supreme Court case to ban “smoke shacks,” which some bars and casinos build to skirt smoke-free laws.

NEBRASKA

• Due to our efforts, the state required critical congenital heart defects screening using the pulse oximetry test for all newborns. More than 20,000 newborns will be screened with the lifesaving procedure every year.

• We secured $160,000 to fund cardiac monitors.

• The legislature appropriated $200,000 for tobacco prevention and cessation — the first increase since 2004.

• The Nebraska State Board of Education approved a measure that requires schools to offer CPR training.

NEVADA

• Volunteers and staff successfully advocated to create a statewide wellness policy that requires public schools to follow the healthy Smart Snacks and Junk Food Marketing guidelines.

• Advocates and partners supported the passage of a $1 increase to the tobacco tax. It is estimated this tax will prevent more than 10,200 Nevada kids from becoming smokers and spur more than 15,400 current adult smokers to quit.

• We supported passage of the Stroke Registry Bill, which requires the state to establish a stroke registry and primary and comprehensive stroke centers to report into the registry.

• We successfully advocated for including Hands-On CPR in the curriculum in the Clark County School District — resulting in more than 300,000 students getting trained over the next 10 years.

Volunteers in Minnesota advocating for children’s health.



NEW HAMPSHIRE

• Passage of the New Hampshire Health Protection Program provided access to healthcare for adults earning up to 138 percent of the federal poverty level. The program is the first step for the uninsured to have access to healthcare services to prevent and manage illness and chronic diseases such as heart disease and stroke.

• Within the first year, when more than 35,000 residents gained health coverage, hospitals saw a 17 percent reduction in the number of uninsured seeking treatment in emergency rooms.

NEW JERSEY

• New Jersey became the 19th state to require CPR training for public high school students prior to graduation.

• Working closely with partners, we created several resources to educate the public on the need for funding for Healthy Corner Stores. We also held several visits at corner stores, inviting decision makers. Governor Chris Christie issued a letter recognizing our efforts.

NEW MEXICO

• The Department of Education approved rules that align with healthy guidelines for competitive foods in schools.

• Volunteers and staff successfully advocated for the passage of legislation that recognizes hospitals as primary, comprehensive or acute stroke ready centers. It also requires EMS protocols for stroke patients.

NEW YORK

• Governor Cuomo approved legislation requiring the Board of Regents to consider requiring CPR training for high school students. We expect the requirement to be implemented during the 2015-16 school year.

• New York prioritized legislation to improve stroke facility designations and access to healthy foods.

Helping America Get MovingPROBLEM:

The United States is in a full-blown obesity epidemic. About 35 percent of people in some states are obese. It’s critical to find ways to increase physical activity opportunities where people live, work, learn and play. However, nearly 50 percent of U.S. adults and 65 percent of adolescents don’t get the recommended amount of daily physical activity.

SOLUTIONS:

Physical EducationThe association advocates for quality physical education in all schools — an important part of a student’s comprehensive, well-rounded education that increases life-long health and well-being.

Shared UsePeople who have easy access to parks or recreational facilities exercise 38 percent more than those who don’t, research shows. Shared use agreements allow school districts, local governments and community organizations to share costs and responsibilities of opening school property to the public after hours.

Built EnvironmentThe association advocates for policies that will build more physically active communities by making everyday activities easier and safer. This includes safe routes to schools and complete streets programs.



• New York City advocated for healthier foods, including a proposed initiative to place a salt shaker icon on menu items that contain dangerous amounts of sodium.

• The city updated standards for child care facilities, improving regulations addressing nutrition, physical activity and limiting screen time.

• NYC’s Lobby Day focused on kids’ health, addressing standards for restaurant meals, curbing sugary drink consumption and improving physical education.

NORTH CAROLINA

• The North Carolina Rules Commission adopted standards for acute stroke ready, primary and comprehensive stroke centers — making North Carolina the second state to designate the three tiers.

• We continued to promote increased access to healthy foods through a Healthy Corner Stores campaign.

• After strong support from our volunteer leadership, the House passed the Healthy Food Small Retailer/Corner Store Act and provided funding for the legislation in its proposed budget. Unfortunately the program was not funded in the final version of the budget but we will continue to support this issue through the next legislative session.

NORTH DAKOTA

• We successfully advocated for passage of stroke systems of care legislation.

• Legislators championed funding CPR in schools at $15 per student in middle and high schools and for acute cardiac registry and system support.

• Public funding for STEMI registry

OHIO

• Advocates celebrated passage of shared use liability coverage, encouraging schools to open their facilities for physical activity opportunities, and an update of AED liability coverage.

• The legislature established a Healthy Food Financing Initiative, but advocates have more work to do on increasing funding and clarifying program details.

• The CPR in Schools bill was reintroduced and heard in the House Committee.

Advocates at the North Carolina Lobby Day

Volunteers and staff at the Ohio Lobby Day



OKLAHOMA

• Volunteers and staff celebrated the successful passage of regulations to recognize comprehensive, primary and acute stroke ready hospitals.

• The AHA worked with stakeholders to successfully advocate for a bill that would develop emergency medical services protocols for assessing, treating and transporting stroke patients.

• Staff and volunteers worked with community partners to establish an obesity prevention coalition in Oklahoma City focusing on healthy food access and paving the way for future polity success.

OREGON

• Volunteers and staff successfully advocated for a bill that makes CPR training a requirement for high school graduation.

• Advocates supported legislation that aligns Oregon’s school nutrition standards with the federal Smart Snack policy.

• Working closely with partners, we protected $4 million each for tobacco prevention and education programs and physical education in schools via Tobacco Master Settlement Agreement funds.

• Staff and volunteers partnered with legislators to introduce an effort to prohibit junk food marketing in schools.

PENNSYLVANIA

• After years of advocating, volunteers celebrated passage of legislation that requires all newborns to be screened for critical congenital heart defects using the pulse oximetry test.

• Staff and volunteers worked hard to ensure the passage of Medicaid expansion, providing access to healthcare for more than 400,000 low income residents.

• Philadelphia passed the largest cigarette tax in history, with a $2 per pack increase.

• The Philadelphia City Council moved to close a loophole in the smoke-free law, an amendment that would prohibit future waivers of the law.

RHODE ISLAND

• We worked closely with Little Heart Heroes and their families to ensure that Rhode Island newborns receive the pulse oximetry test to screen for critical congenital heart defects. About 11,000 Rhode Island newborns will now be screened every year.

Volunteers meeting with Governor Chafee in Rhode Island.

Oklahoma advocates with Governor Fallin at the Stroke Systems of Care Bill signing.



• We partnered with the Rhode Island Stroke Task Force to draft several updates to the state’s landmark Stroke Prevention and Treatment Act of 2009. Revisions included the designation of comprehensive stroke centers and a mandatory annual review of the EMS Pre-Hospital Care Protocol for stroke. The bill was unanimously approved by the House and Senate and signed into law by Governor Gina Raimondo.

• Advocates made significant progress on bills that would update Rhode Island’s school nutrition/competitive foods law and ensure that only healthy foods and beverages are advertised and marketed to children on school property. Both bills were unanimously passed by the Senate and will be a priority in 2016.

SOUTH CAROLINA

• We protected $5 million of tobacco prevention and cessation funding from yearly cigarette tax revenue.

• South Carolina added three more smoke-free communities (Denmark, Duncan and Inman), bringing the total to 61 municipalities enjoying clean air.

Improving Public HealthPROBLEM:

About 83 million U.S. adults suffer from cardiovascular diseases. These life-threatening conditions include coronary heart disease, heart failure, stroke and high blood pressure. More than 2,200 people die from cardiovascular diseases each day — one every 39 seconds. While cardiovascular diseases are the No. 1 killer of all Americans, many racial and ethnic minorities have higher rates. They also have more related risk factors such as high blood pressure and obesity.

The burden is greater for people without health insurance or with inadequate coverage. The uninsured have higher mortality rates and worse blood pressure control. The uninsured and underinsured are also less likely to take medications or get preventive care. A 2010 American Heart Association survey found that more than half of patients with cardiovascular diseases had difficulties paying for medical care, even though most had insurance. Forty-six percent of those who had difficulty paying said they had delays getting needed care.

SOLUTIONS:

Funding for Critical Public Health ProgramsThe association advocates for an increase in public funds to combat heart disease, stroke and factors that increase risk for these diseases. By championing public funding for cardiovascular disease and stroke prevention programs and partnering with our public health partners and agency authorities, we can help ensure financial resources are available. As part of our efforts, we advocate for public funds for initiatives that eliminate health disparities and improve health equity. The association aims to ensure access to quality prevention and treatment for all Americans by improving reporting of healthcare data by sex, race, ethnicity and primary language. We also promote funding programs within offices of minority, multicultural and women’s health.

Ensuring Access to Quality, Affordable CareThe association is working to ensure health coverage is universal, continuous and affordable to individuals and society. This includes promoting public policies that ensure quality healthcare, decreasing disparities in healthcare and putting science-based treatment guidelines into practice. About 16 million adults with a history of cardiovascular diseases and stroke are covered through Medicaid. The association advocates for states to accept federal funds to provide insurance coverage for lower-income people as authorized under the Affordable Care Act. Advocates also work in each state to ensure that Medicaid programs are providing coverage for evidence-based preventive benefits.



• The Senate approved competitive foods legislation — the first school nutrition measure passed in 10 years. The bill ensures schools are meeting USDA nutritional standards and that standards are regularly updated. It also helps parents understand how schools are meeting nutrition standards by reporting compliance in school health improvement plans. The competitive foods bill will carry over into the 2016 session for consideration by the House.

SOUTH DAKOTA

• We advocated for passage of a law that requires motorists to give people on bicycles at least three feet clearance on roads where the speed limit is 25 mph or below. On roads with speed limits higher than 25 mph, motorists must give at least six feet clearance.

• South Dakota schools are implementing stronger physical education standards, thanks in part to our You’re the Cure advocates.

• We continued our efforts with CPR in schools, Medicaid expansion, systems of care and complete streets in Sioux Falls, South Dakota’s largest city.

TENNESSEE

• Volunteers and staff worked tirelessly on stroke designation legislation — getting us closer to the bill passing next session.

• We worked closely with partners to support a solution to the insurance coverage gap. Unfortunately, a few legislators stopped the governor’s plan. If passed, Insure Tennessee will make affordable health insurance available to more than 275,000 residents.

TEXAS

• The AHA team successfully supported campaigns to secure $2 million in funding for the Heart Attack and Stroke Data Collection.

• Volunteer advocates and partners successfully worked to finalize rules that will ensure all babies are screened for critical congenital heart defects using pulse oximetry.

• We helped maintain about $21 million in funding for the Tobacco Cessation and Prevention Program.

• Working with dedicated volunteers and supporters, we cultivated new champions and increased grassroots momentum on the healthy food access issue.

• Advocates worked tirelessly with our coalition partners to enact smoke-free ordinances in Denton, Waxahachie and Burkburnett — protecting almost 200,000 additional residents from the harmful effects of secondhand smoke.

Protecting Babies from Heart DefectsPROBLEM:

Congenital heart defects are the most common birth defect in the United States and the leading killer of infants with birth defects. More than 1,500 babies each year don’t live to celebrate their first birthday. Beyond the terrible toll, families endure physical and mental pain.

SOLUTIONS:

Pulse Oximetry Screening for NewbornsThe pulse oximetry, or pulse ox, is a non-invasive screening test that can save lives by identifying infants with congenital heart defects before they show any signs. The test is simple: Sensors are placed on a baby’s hand and foot to check blood oxygen levels. In 2011, the federal government recommended pulse ox as a standard procedure after birth. The AHA and our partners have successfully advocated in 41 states for pulse ox screening policies.



UTAH

• The State Board of Education passed administrative rules that established healthy standards for foods and beverages sold outside of the breakfast and lunch meal programs.

• We worked with lawmakers to further strengthen tobacco laws, ensuring that those who sell e-cigarettes must be licensed like all other tobacco retailers. This guarantees local health departments can complete compliance checks to ensure products are not sold to minors.

• State lawmakers are closer to passing comprehensive Medicaid legislation that will take advantage of the Affordable Care Act and provide insurance coverage for an additional 54,000 Utahns.

• Locally, we worked with the State Department of Transportation, Utah PTA and Brigham Young University students to help elementary schools throughout Utah County to assess problem areas in their communities related to Safe Routes to Schools.

VERMONT

• Vermont became the first state to pass a sugary drink excise tax through two legislative committees. Although it ultimately did not become law, advocates and volunteers remain committed to the effort.

• The House Health Care Committee passed a 2-cent-per-ounce excise tax to fund healthcare priorities. The House Ways and Means Committee later passed a ½-cent-per-ounce excise tax.

• We prevented a sales tax on bottled water that the Senate Finance Committee proposed in a revenue package that extended a sales tax on soft drinks.

VIRGINIA

• More than 20 advocates and staff came to Richmond as part of our Day at the Capitol prompting legislators to introduce various bills to raise tobacco taxes, including a state tax hike from 30 cents a pack to $2, and allowing counties to increase the tobacco tax locally.

• Volunteers also worked hard to protect standards for healthy food in schools. Legislation that would weaken nutrition guidelines by allowing up to 60 school fundraisers a year was reduced to 30 fundraisers due to the responsiveness of our advocates.

• Advocates and volunteers partnered to finalize rules that will ensure all babies are screened for critical congenital heart defects using pulse ox.

WASHINGTON

• After an historic legislative session that included three special sessions, our advocates and volunteers have much to celebrate: Governor Inslee signed a bill ensuring that every newborn in Washington is screened for critical congenital heart defects.

Improving Quality of CarePROBLEM:

Despite successes in disease prevention, treatment and rehabilitation, significant obstacles may avert scientific advances from medical practice. Part of the problem is government agencies and healthcare facilities aren’t integrated — preventing quality healthcare in many communities.

SOLUTIONS:

Stroke and STEMI Systems of CareA system of care provides seamless transition for each stage of patient care — from the 911 call, to the ambulance, to the ER and to rehabilitation. Employing a statewide system to treat strokes and STEMI heart attacks allows health professionals to determine what works best and what needs to improve. The American Heart Association advocates for coordinated systems in all 50 states to assess each state’s level of stroke and STEMI care, evaluate available resources, and identify and implement opportunities for improvement.



• Governor Inslee signed a 16-year package into law that includes more than $179 million for bicycle and pedestrian safety projects and more than $56 million for Safe Routes to School. This is in addition to $11.4 million from the federal government for Safe Routes to School and the 2015-17 biennial budget appropriations.

• We celebrated a $14.5 million appropriation to the Department of Health, a portion of which will be used for tobacco prevention.

WEST VIRGINIA

• The Mountain State passed legislation that will result in about 17,000 new lifesavers being trained in CPR with psycho-motor compression skills each year in West Virginia.

• Legislators also passed shared use liability legislation to encourage more schools to open their facilities for physical activity after hours.

• With 55 counties in the state are covered by some level of smoke-free air protection, the majority having comprehensive regulations, coalition partners banded together to defeat three bills that would have endangered smoke-free protections.

WISCONSIN

• After years of hard work by advocates, volunteers and our partners, screening for critical congenital heart defects using the pulse oximetry test became a requirement for all babies — even those delivered at home.

• We made significant progress with the legislature on 911 and Emergency Medical Dispatch.

• We successfully fought off cuts in the Tobacco Prevention and Control Fund.

• We successfully held off attempts to pre-empt local governments from including e-cigarettes in smoke-free policies.

• Our successful Lobby Day resulted in an increase in physical education requirements in elementary schools and the number of legislative co-sponsors from the previous session.

WYOMING

• Volunteers and staff successfully advocated for the passage of a bill requiring local EMS to work with the Wyoming Department of Health to develop triage and transport protocols for stroke and STEMI patients. It also includes acute stroke ready hospitals in the designation process.

• Wyoming was the first state to meet the AHA metrics for hospital designations of STEMI centers and the development of EMS protocols. It’s the third state to meet AHA metrics for hospital designations for stroke and EMS protocols.

• Our Wear Red Lobby Day generated more volunteer activities and media coverage than ever.

Advocates with Governor Inslee at the signing for the critical congenital heart defect screening bill.

advocacy pulse 2015 - heart.orgwcm/@global/...congenital heart defects, meaning nearly 900,000 more...

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