AHA principles focus on improving health care for everyone in the U.S.

Improving the health care system to ensure quality care is available, affordable and accessible is critical to equitably increasing life expectancy, according to a presidential advisory published Monday by the American Heart Association in the journal Circulation.

The advisory, a formal review of the science and policy landscape surrounding urgent health issues, outlines key principles to guide practice, policy and research. These principles guide the organization in deciding whether to support health care proposals from candidates for public office and elected officials.

The debate over health care in the upcoming presidential, congressional and state-level elections could have a major impact on the estimated 30 million people in the U.S. who are uninsured and the 44 million who are underinsured. For those people, it’s difficult or impossible to access care that could extend their lives.

“Despite major gains in the number of people with health care coverage over the past decade, millions of people lack health insurance and millions more have coverage that is inadequate to meet their needs,” said John J. Warner, M.D., the advisory’s lead author, past volunteer president of the American Heart Association and executive vice president for health system affairs at University of Texas Southwestern University Hospitals in Dallas. “Health care must be equitable, adequate, accessible and affordable for everyone in this country.”

Underpinning the urgency, progress over the past 50 years in reducing death and disability from heart disease and stroke, the world’s top killers, has stalled. Heart disease patients and those with risk factors who are uninsured or underinsured pay a steep price, with higher mortality rates and poorer treatment and control of diabetes, blood pressure and cholesterol than those with quality coverage.

Uninsured stroke patients face greater neurological impairments, longer hospital stays and are at higher risk of death than patients with adequate coverage.

The AHA’s new principles say health care must be adequate, affordable and accessible for everyone. They also call for eliminating inequities in the health care system, promoting diversity and cultural sensitivity among health care providers, emphasizing value in health care and making health care affordable for individuals, employers, governments and society at large.

The principles also address social determinants of health, which can influence people’s chances of surviving cardiovascular disease and other serious chronic conditions. Addressing inequities in health and health care is more important than ever. The AHA recently announced goals for the next decade calling for equitably increasing healthy life expectancy from 66 to at least 68 years domestically and from 64 to at least 67 years globally by 2030.

“We must address inequities in health and health care that result from where people live, how much they make, their level of education and other social determinants of health,” said Keith Churchwell, M.D., an advisory author, a member of the AHA’s Board of Directors and executive vice president/chief operations officer of Yale New Haven Hospital in New Haven, Connecticut.

The principles build on health care advisories the AHA issued in 1993 and 2008, which focused on improving access to affordable health care and coverage, increasing the availability of evidence-based preventive services and accelerating investments in biomedical research.

American Heart Association CEO Nancy Brown said the principles will be used to respond to health care proposals from federal and state candidates and elected officials.

“We will review proposals on the merits, without regard for ideology or political party, and our analysis will always be driven by what is equitable, evidence-based and in the best interest of patients and consumers,” she said.