Michael V. McConnell, M.D., M.S.E.E., Clinical Professor, Stanford and Senior Research Scientist, Google Health; John Warner, M.D., MBA, Executive Vice President for Health System Affairs and Professor, University of Texas Southwestern Medical Center, and Past President, American Heart Association
It’s an exciting day for the American Heart Association, newly releasing the 2030 Impact Goals and annual Heart Disease and Stroke Statistics Update.
The 2030 Impact Goals, which guide AHA’s mission “to be a relentless force for a world of longer, healthier lives,” are to increase healthy life expectancy from 66 to at least 68 years in the United States and from 64 to at least 67 years worldwide.
To quantify progress toward the mission, the 2030 Goal-Setting Task Force selected the Health-Adjusted Life Expectancy (HALE) metric, commonly referred to as Healthy Life Expectancy.
HALE is the years that a person expects to live in full health by factoring in years lived in less than full health due to disease and/or injury. For example, a woman who has a stroke at 62 and is paralyzed for 18 years before dying at age 80 has fewer healthy years than a woman who has a stroke at 79 and is paralyzed for one year before dying at the same age.
Focusing on HALE in the 2030 Impact Goal allows the AHA to measure its work to improve mortality and prevent disease, as well as efforts to reduce the impact of disease on years lived after the onset of disease and/or disability – for example, to increase the availability and effectiveness of cardiac and stroke rehabilitation.
The HALE metric is well-suited to estimate “longer, healthier lives” in the United States and worldwide because it encompasses both cardiovascular health metrics and cardiovascular and stroke mortality, and national and global HALE estimates are reported annually for nearly 200 countries and territories.
Unfortunately, previous increases in healthy life expectancy are plateauing and even reversing in some populations as people get sicker sooner and die younger.
In light of these trends, the AHA’s goal to increase healthy life expectancy in the United States is ambitious — nearly doubling the forecasted national improvement in HALE by 2030.
Similarly ambitious is the global goal that would add three years of healthy life expectancy among 8.5 billion people. That equals more than 25 billion additional healthy years compared to the decade before.
The 2030 Impact Goals expand the focus of the AHA’s previous Impact Goals to include overall health and well-being and to address equity. Closing the persistent unjust differences in health outcomes between subsets of our population is essential for advancing cardiovascular and brain health and reaching the 2030 goals. Adjusting AHA’s investments and efforts to tackle those disparities will improve individual lives, community health and overall HALE across the United States.
Later this year, the AHA will release specific 2030 targets for health equity and well-being.
- Nearly half (48%) of U.S. adults 20 years and older, representing 121.5 million people, have some form of cardiovascular disease, including coronary heart disease, heart failure, stroke and/or hypertension.
- Cardiovascular disease is the leading cause of death globally, accounting for more than 17.8 million deaths in 2017, an increase of 21.1% from 2007, and expected to reach more than 22.2 million by 2030.
- The average annual direct and indirect costs of CVD and stroke in the United States were an estimated $351.3 billion in 2014-15. Between 2015 and 2035, these costs are projected to increase slightly for middle-aged adults (45-64 years old) and increase sharply for older adults (65+ years).
- A large proportion of CVD is attributed to (in decreasing order of contribution) dietary risks, high systolic blood pressure, high body mass index, high total cholesterol level, high fasting plasma glucose level, tobacco smoking and low levels of physical activity.
Strategies to improve HALE — by increasing length of life, delaying or preventing the onset of disease/illness and reducing the severity of disability — could target these factors that contribute to CVD.
To make where we live, work, learn and play equitably supportive of healthy behaviors and well-being, the AHA endorses:
- Making policy and environmental changes for healthier eating, active living and reduced tobacco use (e.g., taxes on sugary beverages; creating bike lanes; smoke-free air laws).
- Enhancing the effective diagnosis, treatment and control of existing high-risk conditions and substance-use disorders.
- Addressing care coverage and the costs of medications, so people don’t have to make tradeoffs between feeding their families, paying bills and buying medicine.
- Expanding the stock of affordable housing, opportunities to increase educational attainment and improving other social determinants of health.
- Using place-specific and population-based approaches that leverage the work environment and target workforces.
To pursue these lofty 2030 goals, the AHA will apply the organization’s unique triad of science, advocacy and volunteerism and — recognizing that collaboration is imperative to achieve them — build bridges with domestic and global partners.
- The AHA 2030 Impact Goal: A Presidential Advisory from the American Heart Association
- Heart Disease and Stroke Statistics — 2020 Update: A Report From the American Heart Association
- Recommendations for Cardiovascular Health and Disease Surveillance for 2030 and Beyond: A Policy Statement from the American Heart Association