Creating Incentives to Improve Lifestyle for a Healthier Heart
February 27, 2020 | ASTHO Staff
February is Heart Month, a time to not only celebrate our love for others but also the organ that pumps us full of life. According to CDC, heart disease-related deaths continue to be the leading cause of death in the U.S. High blood pressure, unhealthy cholesterol levels, diabetes, and obesity are key risk factors for developing heart disease. These risk factors are often related to lifestyle choices, such as unhealthy diets, a lack of physical activity, and tobacco use. These behaviors are often influenced by one’s environment, whether they have access to healthy and fresh foods, and opportunities to engage in safe, physical activity.
Policies that increase access to quality food and physical activity for both children and adults could help to improve heart health—it can encourage healthy behaviors that reduce the risk factors for developing heart disease. Below is an overview of state legislation from this year that would increase access to nutritious food, wellness opportunities, and incentives to improve heart health.
Improving Access to Healthy and Affordable Food
Food deserts are neighborhoods with limited access to supermarkets, grocery stores, or other means of accessing nutritious and affordable food. Food deserts have been linked to worse cardiovascular outcomes compared to individuals living in non-food desert areas. In 2010, 23.5 million Americans were impacted by food deserts. One study found that low-income counties had more unhealthy food retailers compared to higher-income counties. To bring food retailers to food deserts, lawmakers can create financial incentives to help increase access to healthy foods, decrease the chances of at-risk populations experiencing cardiovascular disease, and reduce the number of heart-related deaths in these areas.
In Washington State, a bill (SB 5583) was introduced to create a fruit and vegetable incentive program which aims to increase fruit and vegetable consumption among individuals with limited incomes. Indiana (SB 356) and Virginia (SB 1073) are considering similar bills that would develop a healthy food investment program. The programs would provide loans or grants to fund construction, equipment upgrades, expansion of grocery stores, and food retail projects that serve underserved communities. These communities would be identified using data from the United States Department of Agriculture, and the programs would also require stores to accept the Supplement Nutrition Assistance Program (SNAP) benefits.
While children may not immediately be at risk of cardiovascular disease or heart-related death, increasing access to affordable and healthy food can help develop dietary habits in their youth that prevent heart disease later in life. Since children spend a significant part of their early life in schools, policies that target schools can help ensure they have access to nutritious meals. For example, in West Virginia, the legislature is considering a bill (HB 2778) to provide a take home meal for low-income students from pre-K through 12th grade as part of the school nutrition program.
Encouraging Children and Adults to Stay Active
To prevent chronic disease, the U.S. Department of Health and Human Services (HHS) recommends 60 minutes of daily physical activity for children and 75 to 150 minutes per week for adults. However, evidence shows that only one in three children are physically active every day. Adults also are not meeting recommended physical activity, with only a third of adults meeting the physical activity guidelines.
Promoting physical activity early in a child’s life can encourage behaviors that will help lower their future risk of developing heart disease. Policymakers can strengthen schools’ commitment to helping students meet physical activity requirements. For example, a West Virginia bill (SB 702) would establish physical activity requirements by grade and would allow school districts to develop and adopt their own nutrition and exercise education programs. Programs can focus on the importance of nutrition and exercise to prevent childhood obesity and its secondary diseases, such as diabetes, heart disease, and hypertension. If enacted, the bill would also create a Nutrition and Exercise Fund to implement the program.
Policies that require or authorize employers and health insurers to create financial incentives may encourage adults to increase physical activity and reduce the risk of cardiovascular disease and heart-related deaths. In Mississippi, there is a bill (SB 2289) to provide an income tax credit to employers that cover qualified wellness program costs. The qualified wellness program must include a certain number of components including: a health awareness component; management of lifestyle issues such as tobacco use, physical fitness, and nutrition; a behavioral change component; and a supportive environment for wellness component, which encourages employees to take part in physical activity before or after work. In New York, a bill (A7472) would allow individuals with health insurance to receive a reduction in premium rates or other benefits for participating in a wellness program that identifies at-risk populations, helps to promote physical and mental fitness, helps to prevent or mitigate conditions of acute or chronic sickness, disease, or pain, or minimizes adverse health consequences due to lifestyle. Wellness programs may include education about healthier lifestyles and early identification or treatment of diseases such as heart disease, hypertension, diabetes, and obesity.
State health agencies are well positioned to support improved access to healthy foods in schools and food deserts--as well as workplace wellness policies and healthcare systems reimbursement programs. ASTHO will continue to monitor legislative activity that explicitly addresses heart health as well as policies that target behaviors and interventions to reduce heart-related deaths.