California State Profile and Policy Report

California Heart Disease and Stroke: State Profile and Policy Report

Heart Disease and Stroke Burden

Table of Contents

California - State Deaths for Heart Disease and Stroke

  • More than 1 out of 4 deaths in California are due to heart disease.

  • 64,871 Californians died from heart disease in 2006 (27.4 percent of total deaths in California).

  • 15,039 Californians died from stroke in 2006 (6.3 percent of total deaths in California). 
    Source: National Vital Statistics Report, 2009.


California - 2007 State Risk Factors for Heart Disease and Stroke


California - 2003 State Costs for Cardiovascular Disease

In October 2007, the Milken Institute, an independent research group, released a study, An Unhealthy America: The Economic Impact of Chronic Disease. The study details the economic effects of treatment costs resulting from chronic disease in the United States. Below is a breakdown of California’s estimated medical costs to treat heart disease, hypertension and stroke based on 2003 Medical Expenditure Panel Survey data.  

California Annual Cost of Hypertension, Heart Disease and Stroke 

Treatment Expenditures (Direct Costs) - Total annual medical cost.


$3.12 billion

Heart Disease          

$6.0 billion


$1.29 billion

Source: Milken Institute, An Unhealthy America: The Economic Impact of Chronic Disease, October 2007. 


California - Estimated 2007 Medicaid Treatment Costs for Cardiovascular Diseases

Based on California's Medicaid population, economic estimates for 2007 were projected using Medical Expenditure Panel Survey data.  Medicaid spending has grown rapidly in recent years, placing a significant burden on state budgets.  To help states estimate the financial impact of cardiovascular diseases among their Medicaid beneficiaries, the Centers for Disease Control and Prevention (CDC) and RTI International developed the Chronic Disease Cost Calculator. 


Heart Disease

$784 million


$2.3 million


$1.6 million

Congestive Heart Failure     

$329 million 


Funded CDC Heart Disease and Stroke Prevention Grantees in California

The Centers for Disease Control and Prevention (CDC) funds California's Heart Disease and Stroke Prevention program to increase control of high blood pressure and cholesterol; increase awareness of the signs and symptoms of heart attack and stroke and the importance of promptly calling 911; improve emergency response; improve quality of care; and eliminate related health disparities.  These efforts are informed by monitoring heart disease, stroke and related risk factors statewide.

California State Highlight - Heart Disease and Stroke Prevention Program

  • The California Heart Disease and Stroke Prevention (HDSP) program contracts with the Health Information and Strategic Planning Section of the California Department of Health Services to conduct geographic information system (GIS) surveillance mapping analyses of heart disease and stroke events and disease trends. GIS enables the HDSP program to overlay geographic areas with high rates of heart disease and stroke with the available clinical and community resources. These analyses are being used to inform policy decisions about the accessibility and use of limited resources.

WISEWOMAN - The CDC also funds the WISEWOMAN program, which provides low-income, underinsured and uninsured women ages 40 to 64 with access to preventive health services by screening for high blood pressure, high cholesterol and diabetes.  The program also provides lifestyle interventions that are tailored to each woman's heart disease and stroke risk factor screening results and links participants to free and low-cost community-based nutrition, physical activity, and quit smoking resources. 

  • In California, the WISEWOMAN program is called Heart of the Family or Corazon de la Familia.  Current California sites participating in Heart of the Family program are:
    · Olive View - UCLA Education and Research Institute/ Mid-Valley Comprehensive Health Center, Los Angeles County
    · Queens Care Family Clinics, Los Angeles County
    · Vista Community Clinic, San Diego County
    · Family Health Centers of San Diego, San Diego County

State Laws and Policies

Public Awareness of Heart Disease and Stroke

CA ACR 8 (2011, adopted, Resolution Chapter No. 2) - Recognizes the month of February 2011, as “American Heart Month” and February 4, 2011, as “Wear Red Day,” to raise awareness that heart disease is the leading U.S. cause of death for women. Encourages public support for “Go Red for Women” events.

CA SCR 87 (2010, adopted, Resolution Chapter No. 25) - Declares May 2010 as “American Stroke Month” and urges all Californians to become familiar with the risk factors, and warning signs and symptoms associated with stroke.

CA SCR 64 (2010, adopted, Resolution Chapter No. 2) - Recognizes the month of February 2010 as “American Heart Month” and February 4, 2010, as Wear Red Day in California.

CA ACR 17 (2009, adopted) - This measure recognizes the month of February 2009 as American Heart Month in California, recognizes February 6, 2009, as Wear Red Day in California, and urges public support for Go Red for Women events.

SCR73 (2008, adopted) - This bill establishes February 2008 as American Heart Month and February 1, 2008, as Wear Red Day. The Legislature recognizes the month of February 2008 as American Heart Month in California in order to raise awareness of the importance of the ongoing fight against heart disease and stroke. The Legislature recognizes February 1, 2008, as Wear Red Day in California, and urges all citizens to show their support for women and the fight against heart disease by commemorating this day by wearing the color red. The Legislature urges public support for Go Red for Women events planned in their community during the 2008 American Heart Month.

SCR114 (2008, adopted) - This measure declares May 2008 as American Stroke Month in California and urges all Californians to familiarize themselves with the warning signs, symptoms, and risk factors associated with stroke to reduce the devastating effects of stroke on the population.

ACR159 (2006, adopted) - The Legislature proclaims September 12, 2006, as Sudden Cardiac Awareness Day, and designates the state’s observance of September 12 of following years as a commemorative holiday for public schools and public agencies to observe Sudden Cardiac Awareness Day thereby honoring and memorializing those who have fallen victim to sudden cardiac arrest, and celebrating those who have survived by the timely use of an automated external defibrillator and cardiopulmonary resuscitation.

ACR93, ACR18 (2003, adopted) - Proclaims May 2003 and 2005 as American Stroke Awareness Month with emphasis on educating the public on the signs, symptoms and risk factors for stroke.

Prevention of Risk Factors (Nutrition, Physical Activity, Tobacco)

Tobacco Control

California's state employee tobacco cessation program meets all three of the CDC's guidelines that include:

1) Coverage for at least four counseling sessions of at least 30 minutes; YES 
2) Access to smoking cessation agents, including prescriptions and nicotine replacement; YES
3) Counseling and medication coverage for at least two quit attempts annually; YES 

  • California also has a statewide tobacco-free policy, cigarette excise tax and quit line.  The $ .87 California cigarette excise tax is used to fund tobacco control programs.

  • California's state Medicaid tobacco cessation program covers over-the-counter and prescription products, therapy, counseling and social support.

CA ACR 8 (2009, adopted) - This measure proclaims the month of May 2009 as California Fitness Month, and would encourage all Californians to enrich their lives through proper diet and exercise. Exercise and fitness activities are excellent ways to relieve stress, lower the risk of heart disease and diabetes, prevent bone loss, and decrease the risk of some cancers.

Increase Early Detection and Treatment of Heart Disease and Stroke

SJR21 (2006, enacted) - This measure memorializes the president and Congress of the United States to take necessary action to enact HR 1252, thus amending the Public Health Service Act to provide for a program of screenings and education regarding children with sudden cardiac arrhythmia syndromes.

Health and Safety Code 104100-104140 (2005) -  The Legislature finds and declares that high blood pressure, also known as hypertension, is a widespread and serious public health problem in California. The department shall conduct a program for the control of high blood pressure. The program shall include, but not be limited to, all of the following: (a) Support of local community high blood pressure control programs to improve the quality and distribution of high blood pressure control services. (b) Promotion of consumer participation in high blood pressure control efforts. (c) Statewide coordination of high blood pressure control activities. (d) Planning, including development, adoption, periodic review, and revision of a state plan for high blood pressure control; and assistance to local agencies in their planning efforts. (e) Gathering, analysis, and dissemination of epidemiologic data and information on high blood pressure and its resulting effects, and support of high blood pressure research. (f) Development and maintenance of a clearinghouse for high blood pressure information, materials, and services. (g) Promotion of local and regional councils on high blood pressure control. (h) Evaluation of high blood pressure control efforts. (i) Education of patients, health professionals, and the general public. Commencing July 1, 2007, every health studio, as defined in subdivision (g) shall acquire an automatic external defibrillator. The requirement to acquire an automatic external defibrillator pursuant to this subdivision shall terminate on July 1, 2012.

Health and Safety Code 100350 (2005) - The Legislature finds that many programs of the department are hindered by the length of time required for the state to execute contracts and pay vendor claims. These programs include, but are not limited to, community hypertension, rural health services development, family planning, genetic counseling, supplemental feeding program for women, infants, and children, sickle cell disease and newborn screening projects. It is the intent of the Legislature that advance payment authority be established for the department in order to alleviate those problems for those types of contractors to the extent possible. Notwithstanding any other provision of law, the department may, to the extent funds are available, provide for advance payments for services to be performed under any contract, with a total annual contract amount of two hundred thousand dollars ($200,000) or less, that the department determines has been entered into with any small, community-based public or private nonprofit agency with modest reserves and potential cash-flow problems. 


State Employee Health and Wellness

  • California: CalPERS offers lower health premiums in 2009 if members enroll in one of the "newer" plan options – Blue Shield of California NetValue (HMO) and PERS Select (PPO). These “high-performance network” plans provide the same level of benefits and quality of care as Blue Shield Access+ HMO and PERS Choice, respectively. The difference is that enrollees pay a lower premium in exchange for choosing from a smaller panel of physicians.  A California example: "To illustrate the value of a high performance network plan, let’s use the example of a State member who currently has health coverage for herself and her family (husband, 4-year old child, and a baby on the way) through Blue Shield. If this member transfers from the standard Blue Shield Access+ HMO family plan to Blue Shield NetValue, she would save more than $1,800 in premiums in 2009. She could use this savings to pay for additional health care services for her family, such as co-payments for 20 office visits for non-preventive care, 20 retail generic drug prescriptions, 20 retail brand prescriptions, 4 mail-order brand prescriptions, 4 mail-order nonformulary prescriptions, 12 urgent care visits, and 4 emergency room visits (without being admitted) – and still keep an extra $348 in her pocket." [2009 plan booklet]

  • In 2004 CalPERS, the second-largest U.S. pension fund, paid 18.4 percent more for health insurance under a draft contract with the HMO networks that provide coverage to its 1.2 million members. The increases were less than the 25 percent rate hike that CalPERS approved for 2003 and below the initial bids that had pointed to a 31 percent insurance rate hike for next year would cost $3.95 billion, up from $3.34 billion in the current year, Calpers said. The HMO package covered about 70 percent of CalPERS' health benefits costs.  Benefits in the Balance: The Uncertain Future of Public Retiree Health Coverage  - released by CA Health Care Foundation,  9/06.

  • Cal. Resolution Chapter No. 38 (2007) (SCR 31) (adopted) - Recognizes the importance of health and wellness in communities and the role planning plays in keeping the state and communities healthy and declares May as Healthy Communities Month.

California has "a law, policy, court decision or union contract that provides state employees with domestic partner benefits."  Normally health care is covered by the term "benefits." (Human Rights Campaign, 05/06). 

Improve Quality of Care and Access to Care

Health and Safety Code 150-152 (2006) - The Office of Multicultural Health is hereby established within the State Department of Public Health. The office shall do all of the following on behalf of the State Department of Health Care Services and the State Department of Public Health: (1) Perform strategic planning, conduct departmental policy analysis on specific issues related to multicultural health, coordinate pilot projects, identify the unnecessary duplication of services and future service needs, communicate and disseminate information, perform internal staff training, serve as a resource for ensuring that programs keep data and information regarding ethnic and racial health statistics, strategies and programs that address multicultural health issues [including cardiovascular disease], and provide technical assistance to counties, other public entities, and private entities seeking to obtain funds for initiatives in multicultural health, including identification of funding sources and assistance with writing grants.

Health and Safety Code 106000-106036 (2004) - The Urban Community Health Institute: Centers to Eliminate Health Disparities was established at the Charles R. Drew University of Medicine and Science to address the problem of disparate health care in the Los Angeles County Service Planning Area (SPA 6) and other multicultural communities that have the worst health care status indicators, medical outcomes, and death rates in Los Angeles County. The institute shall be organized into three clinical centers, including the Stroke and Hypertension Center, the Obesity and Nutrition Center, and the HIV/AIDS Center.

Health and Safety Code 127670-127671 (2004) - California's health care system needs to be reformed to provide high quality accessible, affordable, and equitable care and treatment. It is the intent of the Legislature to make available valid performance information to encourage hospitals and physicians to provide care that is safe, medically effective, patient-centered, timely, efficient, and equitable. It is also the intent of the Legislature to strengthen the ability of the Office of Statewide Health Planning and Development to put hospital performance information into the hands of consumers, purchasers, and providers. It is the intent of the Legislature to encourage health care service plans, health insurers, and providers to develop innovative approaches, services, and programs [including disease management strategies for chronic conditions such as heart disease and stroke] that may have the potential to deliver health care that is both cost-effective and responsive to the needs of enrollees. The Governor shall convene the California Health Care Quality Improvement and Cost Containment Commission, hereinafter referred to as "the commission," to research and recommend appropriate and timely strategies [including disease management] for promoting high quality care and containing health care costs.

Health and Safety Code 104500-104545 (1995) - It is the intent of the Legislature to provide for the continuation of the Cigarette and Tobacco Products Surtax Research Program to support research into tobacco-related disease. It is the intent of the Legislature that this program be administered by the University of California and that this program be administered pursuant to the following principles: " The Legislature hereby requests the University of California to continue to administer a comprehensive grant program to support research efforts related to the prevention, causes, and treatment of tobacco-related diseases. [including coronary heart disease and cerebrovascular disease.]

Health and Safety Code 100525-100540 (1995) - Notwithstanding any other provision of law, the department shall review the following categorical programs and develop a procedure by which a contracting nonprofit organization is notified at the execution of a contract of the terms and conditions relating to the allowable costs associated with personnel, primary care grants-in-aid, maternal and child health, family planning, women, infant and children, dental disease prevention, child health and disability prevention, California children's services, preventive health care for the aging, rural health services, farmworker health services, California health services corps, American Indian health services, genetically handicapped programs, hypertension, perinatal health services, immunization, adolescent family life, and other programs that the department wishes to include within the scope of this article.


Address and Eliminate Disparities

ACR133 (2008, adopted) - This measure recognizes May 2008 as “Black Barbershop Health Outreach Month” and encourages outreach on health disparities at all barbershops throughout California. Volunteers for the Black Barbershop Health Outreach Program will measure blood pressure, screen for diabetes, and refer customers to participating physicians or health care facilities if there are abnormal findings. The primary objective of the Black Barbershop Health Outreach Program is threefold: cardiovascular testing, information dissemination, and referral. The goal of the Black Barbershop Health Outreach Program is to use the existing community-based infrastructure of African American-owned barbershops to conduct health care screenings to approximately 2,000 African American men, provide culturally appropriate educational materials about obesity, prostate cancer, proper eating habits, and give information about the signs and symptoms of other diseases affecting the African American community.

Health and Safety Code 100237-100239 (2000) - This article shall be known, and may be cited as, the "Inclusion of Women and Minorities in Clinical Research Act."  In conducting or supporting a project of clinical research [including research on cardiovascular disease], a grantee [conducting clinical research using state funds] shall do all of the following: (1) Ensure that women, including, but not limited to, women over the age of 40 years, are included as subjects in each research project. (2) Ensure that minority groups are included as subjects in each research project. (3) Conduct or support outreach programs for the recruitment of women and members of minority groups as subjects in projects of clinical research.


Emergency Medical System (EMS) and Automated External Defibrillators (AED)

Business and Professional Code 1756.2 (2008) - In addition to the requirements of Section 1755, the following criteria shall be met by a dental sedation assistant permit course to secure and maintain approval by the board. All students, faculty, and staff involved in the direct provision of patient care shall be certified in basic life support procedures, including the use of an automatic electronic defibrillator.

Health and Safety Code 1797.196/AB2083 (2006) - In order to ensure public safety, any person or entity that acquires an AED is not liable for any civil damages resulting from any acts or omissions in the rendering of the emergency care under subdivision (b) of Section 1714.21 of the Civil Code.

ACR57 (2005, adopted) - This measure urges all California public schools maintaining kindergarten or any of grades 1 to 12, inclusive, to implement an automated external defibrillator program in order to save the lives of pupils, teachers, staff members, and visitors suffering from sudden cardiac arrest in schools.

Health and Safety Code 1797.190/ AB2041 (2002) - "Only those individuals who meet the training and competency standards established by the authority shall be approved for and issued a prescription authorizing them to use automated external defibrillators." 

SB911 (1999, enacted) - This legislation provided an exemption from liability for automated external defibrillator trained laypeople under the state Good Samaritan Law.

Civil Code 1708-1725/AB2041 (2002) - This legislation changed liability provisions; all people are exempt from liability under the state Good Samaritan Law. Anyone who, in good faith and not for compensation, renders emergency care or treatment by the use of an AED at the scene of an emergency is not liable for any civil damages resulting from any acts or omissions in rendering the emergency care. The protections specified in this section do not apply in the case of personal injury or wrongful death that results from the gross negligence or willful or wanton misconduct of the person who renders emergency care or treatment by the use of an AED. Nothing in this section shall relieve a manufacturer, designer, developer, distributor, installer, or supplier of an AED or defibrillator of any liability under any applicable statute or rule of law.

Stroke Systems of Care

CA ACR 54 (2011, enacted, Chapter No. 67) – Would encourage people to take action during American Stroke Month 2011, and participate in "Take 2 to Save 2", take two minutes to send a health message about stroke warning signs to two people who smoke, are overweight, have high blood pressure, diabetes and a family history of heart disease or stroke. Would also promote the "Power to End Stroke" program to reduce stroke in African Americans by empowering them to reduce their risk, recognize the warning signs and respond quickly.
CA AB 861 (2011, pending, Senate Committee on Health) -  Would require the state department of health to administer and establish a registry that collects stroke data on quality improvement measures for acute stroke treatment. The bill would require the program be implemented only to the extent funds from federal or private sources are made available.
CA AB 1220 (2003, enacted) - Created the Heart Disease and Stroke Prevention and Treatment Task Force in the State Department of Health Services.  The task force develops a state plan and strategies to prevent, control and treat those at risk for heart disease and stroke.

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