Funding Cuts Limit Success of Women’s Heart Programs

STAGNANT FUNDING AFFECTS WOMEN'S HEART HEALTH, COMMUNITY PROGRAMS, AND COMMUNITY RESOURCES

FEATURING: Litia Garrison, Women’s Health Program Manager, Southeast Alaska Regional Health Consortium, Sitka, Alaska

 

Fighting the #1 Killer of Women

Cardiovascular disease (CVD) is the leading cause of death of American women. It is responsible for one in three female deaths in the U.S.i For women 35-44 years of age, the rate of death attributable to coronary heart disease has been increasing by an average of 1.3 percent annually, while comparable rates among men have been falling.ii

More than 42.9 million women are currently living with some form of CVD and more women than men die of CVD each year. In fact, 26 percent of women older than 45 will die within one year of a first recognized heart attack; 47 percent of women heart attack survivors will die within five years. It is frightening that 64 percent of women who die suddenly from coronary heart disease had no previous symptoms of this disease.iii

In response to the high incidence of heart disease in women, the Centers for Disease Control and Prevention (CDC) launched the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program. WISEWOMAN provides chronic disease risk factor screening, lifestyle programs, and referral services to low-income, under-insured or uninsured women aged 40–64 years in an effort to prevent CVD. The program—administered through Division for Heart Disease and Stroke Prevention (DHDSP) at CDC—targets women who are at high risk for developing CVD, stroke and diabetes. They receive screenings and are offered testing, medical referral and follow-up, as appropriate. Participants also take advantage of healthy cooking classes, walking clubs, tobacco cessation resources or lifestyle counseling. The interventions are designed to promote lasting, healthy lifestyle changes and can be tailored to meet local needs.

Low Cost and High Yield

Not only does this program see positive results in the health status of the women it serves, it also saves money. Health economists generally agree that if an intervention can save one year of life for less than $50,000, it is cost-effective. Studies of WISEWOMAN found that its programs have extended women’s lives at a cost of $4,400 per estimated year-of-life saved.iv An early study of the program concluded that by targeting financially disadvantaged, uninsured, and multiethnic women, WISEWOMAN projects are reaching women who are at high risk of developing CVD and other chronic diseases. Initial baseline results suggest that before enrolling in WISEWOMAN, many of the women were unaware of their high blood pressure or their high cholesterol, nearly three quarters of the women were overweight or obese, and the prevalence of smoking was also higher than would be expected.v Thanks to this program, these women are becoming better educated about their health and the impact their lifestyles have on their well being.

Many Women Remain Without Access

According to a 2009 report from the Alaska Health Department, the prevalence of several key heart disease and stroke risk factors is high in Alaska, particularly in subgroups with relatively low income and education.vi These disparities are especially challenging to address, as they require interventions, such as WISEWOMAN, aimed at marginalized and poorly organized populations. Thirty–six percent of American Indians and Alaska Natives who die of heart disease die before age 65, which is younger than other racial and ethnic groups in the United States.vii The data also indicate a significant gender gap in the treatment of female hospital patients with ischemic heart disease, who are consistently less likely to receive angiography or arteriography, cardiac catheterization, angioplastys, or bypass surgery.viii

Litia Garrison serves as the WISEWOMAN Women’s Health Program Manager for the Southeast Alaska Regional Health Consortium (SEARHC). In this role, Litia runs clinics in remote areas that are often the only source of care for women in the area. Their programs have successfully established a positive culture around being a “WISEWOMAN.” She attributes their success to using the WISEWOMAN program as a springboard to connect with community partners and leverage community resources. Through educational programs such as healthy cooking classes and education on becoming more physically active, the WISEWOMAN program in Alaska has seen decreases in blood pressure and increases in physical activity and high-density lipoprotein levels among its participants. Working collaboratively with the SEARHC tobacco prevention and control has also resulted in a 12 percent decrease in reported smoking rates among Alaska Natives, region wide. This improved health status will be both beneficial and cost effective now and when they become Medicare beneficiaries.

Due to the risk profile of their target audience, SEARHC has permission from CDC to screen and support women starting at age 30. However, there are still many more Alaskan women who would benefit from the WISEWOMAN program. Litia stated, “With additional funding, the program could be expanded statewide to both native women and non-native women who are underinsured or uninsured. Right now we are only reaching a small proportion of the women in Alaska.”

While Alaska struggles with their WISEWOMAN program being underfunded, other programs have lost funding altogether due to federal budget cuts. In 2013, Connecticut lost all of its federal funding for the WISEWOMAN program, joining the ranks of 29 other states and 564 tribes who will not have the resources available to educate and provide health screening to women at high risk of heart disease.

Without WISEWOMAN, low-income, uninsured, and underinsured women ages 40-64 in Connecticut and across the country may not have their hypertension, high cholesterol, and diabetes detected. Without early detection, these conditions can progress to acute clinical cardiovascular events. This translates to higher personal and economic costs for what can often be a preventable disease. Even newly insured women in Connecticut will miss the opportunity to receive education, risk reduction counseling, and lifestyle modification counseling they need to start on the road to heart health.

Inadequate funding reduces the number of women who benefit from the life changing opportunities this program offers. As long as heart disease remains the number one killer of women, funding for programs that make women aware of their risk and help them be heart healthy should be increased.


AUTHOR
WomenHeart: The National Coalition for Women with Heart Disease

SOURCES
i Alan S. Go, et al., “Heart disease and stroke statistics--2014 update: a report from the American Heart Association,” Circulation 128 (2014):117, doi: 10.1161/01.cir.0000441139.02102.80.

ii Go et al., “Heart disease,” 203.

iii Go et al., “Heart disease,” 202.

iv Julie C. Will, Rosanne P. Farris, Charlene G. Sanders, Chrisandra K. Stockmyer, and Eric A. Finkelstein, “Health Promotion Interventions for Disadvantaged Women: Overview of the WISEWOMAN Projects,” Journal of Women’s Health 13.5 (2004): 484-502, doi:10.1089/1540999041281025.

v Julie C. Will et al., “Health Promotion Interventions” 484-502.

vi Andrea Fenaughty et al., “The burden of heart disease and stroke in Alaska: Mortality, morbidity, and risk factors, December 2009 update,” State of Alaska Department of Health and Social Services (2009). http://dhss.alaska.gov/dph/Chronic/Documents/Cardiovascular/pubs/burden_dec09.pdf

vi Center for Disease Control, “American Indian and Alaska Native Heart Disease and Stroke Fact Sheet,” accessed 5/2/2014. http://www.cdc.gov/dhdsp/datastatistics/factsheets/docs/fs_aian.pdf

vii Fenaughty et al, “Heart disease and stroke.”