Brief State Actions to Improve Cardiovascular Health

Cardiovascular disease, also referred to as heart disease, is the current leading cause of death in the United States, impacting more than half of adults in the U.S., according to the American Heart Association. Heart disease encompasses a range of conditions that affect the heart—such as arrhythmia, heart failure, coronary artery disease and cardiac arrest. By 2050, the heart association projects a growth in the prevalence of cardiovascular disease by at least 4%. 

Heart disease can impose a significant economic burden on the United States. From 2019 to 2020, it was responsible for over $252 billion in combined direct health care expenses—such as medical services and prescription drugs, as well as indirect costs, such as lost wages and reduced productivity. The American Heart Association reports annual health care costs of cardiovascular risk factors are projected to triple between 2020 and 2050. 

Populations Disproportionately Impacted by Cardiovascular Disease 

Studies suggest cardiovascular disease can disproportionately affect certain populations due to geography, race/ethnicity, socioeconomic status and other factors.  

People living in rural communities can experience higher mortality from cardiovascular disease due to reduced access to health care services, fewer providers and limited financial resources. Sixty-one percent of areas deemed as health professional shortage areas are located in rural communities across the U.S. According to the American Hospital Association, elevated rates of rural hospital closures in the last decade left residents traveling over an hour to receive care. 

Cardiovascular health outcomes can vary significantly among different racial and ethnic groups. According to an American Heart Association study, Black individuals experience higher rates of cardiovascular disease and related deaths in comparison to white adults. American Indians and Alaska Natives have the lowest life expectancy among all other racial groups, with heart disease as the leading cause of death. Additionally, Hispanic communities are reported to have the highest rates of certain risk factors for heart disease—high blood pressure, obesity and diabetes.  

Cardiovascular disease is a leading cause of pregnancy-related deaths in the U.S., contributing to up to 33% of pregnancy-related maternal deaths. Studies estimate that up to 68% of these deaths are preventable. Women with high-risk factors—such as advanced maternal age, obesity, or preexisting conditions—face a greater likelihood of cardiovascular complications. Preeclampsia, a serious blood pressure condition, is another risk factor women may develop during pregnancy. Women of color, specifically Black women, experience the highest rates of preeclampsia and are three times more likely to die from pregnancy-related complications than other women. In 2019, over $12 billion was spent on heart-related maternal health care. 

Socioeconomic status—the overall economic resources, power and prestige based on income, education, and employment status, among others—is another risk factor for cardiovascular disease. People with lower income and less education often face a higher prevalence of modifiable cardiovascular risk factors like smoking, poor diet, lack of physical activity, obesity, and high stress levels, which contribute to their increased risk of developing and dying from cardiovascular disease. Compared with higher-income individuals, those experiencing poverty consume fewer fruits and vegetables and often rely on cheaper, lower quality foods. Addressing food deserts, areas with limited access to affordable and nutritious food, may reduce the risk of heart disease for low-income populations.  

State Actions to Address Cardiovascular Disease 

State policymakers are addressing cardiovascular disease through legislative efforts aimed at improving health outcomes, especially for those populations with disproportionately higher rates of heart disease. These efforts include improving access to health care services, strengthening the workforce by recruiting and retaining culturally competent providers, establishing grant programs and advisory councils, and increasing access to affordable, healthy foods to prevent cardiovascular disease.  

Improving Access to Health Care Services, Including Maternity Care 

States are improving access to cardiovascular health services in rural areas through targeted policies. Ohio is bolstering telemedicine access in rural communities, enabling usage of remote monitoring of patient’s blood pressure, heart rate and glucose levels. By connecting with medical care providers virtually, patients can save time and money that would have been spent travelling long distances. Texas established the Medical Transportation Program for eligible Medicaid recipients, providing free transportation to and from medical services. Oregon created the Mobile Health Unit Pilot Program to support mobile medical services that are culturally and linguistically conscious.  

Access to affordable and quality maternal care can prevent complications and deaths, particularly in high-risk populations. In recent years, states, like Maryland, enacted legislation requiring routine blood pressure monitoring during pregnancy, access to specialists and educational resources for both providers and pregnant women. Illinois lawmakers established the Task Force on Infant and Maternal Mortality Among African Americans, which seeks to reduce rates of preventable conditions, like risk factors for heart disease. The task force was created to “establish best practices to decrease infant and maternal mortality among African Americans in Illinois” and annually reports its findings to the Illinois General Assembly.  

Recruiting, Retaining and Reimbursing the Health Care Workforce 

To address the shortage of health care providers in rural communities, states are using strategies such as modifying scope of practice for certain health professions, providing Medicaid reimbursement for community health workers and offering loan forgiveness for providers.  

Arkansas expanded the scope of practice for advanced practice registered nurses, allowing them to serve as primary care providers without the previous requirement of working under the supervision of a physician.  

According to the CDC, integrating community health workers on clinical care teams or in the community can help reduce risk factors associated with heart disease, such as hypertension and cholesterol levels. In 2023, Colorado joined the 31 other states providing Medicaid reimbursement for community health worker services.  

Alabama established a service payback loan program for eligible medical students who commit in writing to practice in rural areas of the state. Loans are repaid by the recipient working full time each year, for up to three years, in a rural Alabama area with a primary care provider shortage.  

Establishing Grant Programs and Advisory Councils  

Lawmakers across the nation are establishing grant programs to address barriers to accessing care.  

Colorado awards grant funds to culturally based community organizations that “address prevention, early detection, and treatment of cancer and cardiovascular and pulmonary diseases in underrepresented populations.” Funding is provided through appropriations from the General Assembly and taxation on tobacco products.  

Mississippi created a health disparities council to provide recommendations to the state legislature for reducing health disparities, including cardiovascular health. With the council’s guidance, a language access plan is underway, which aims to provide medical materials and documents to non-English speakers and those individuals needing interpreters.  

Increasing Availability of Healthier Foods in Underserved Communities 

Several states are considering programs to increase the availability of affordable, healthy food to promote wellness and reduce the risk of preventable diseases, like cardiovascular disease. Arkansas set up a "Farm to School and Early Childhood Education Program" to help children statewide eat healthier, learn about farming and boost local food systems. The program also creates a coordinator position to manage the program and increase local food in schools. California’s state health department provides grants to local governments, nonprofits and schools to support programs promoting consumption of fresh fruit and vegetables, prevent obesity and encourage healthy eating in underserved and rural communities.  

Federal Action 

The federal government is also taking steps to address cardiovascular health disparities in the United States. The Million Hearts initiative aims to prevent one million heart attacks and strokes over five years by improving cardiovascular care and promoting healthier lifestyles. Currently, 37 states have participated in the Hypertension Control Champions, a partner engagement program with Million Hearts.  

Federal agencies like Office of Disease Prevention and Health Promotion are establishing health programs to improve cardiovascular health through management of individual risk factors. Food is Medicine is a federal program that aims to improve health and access to nutritious food, including a focus on preventing high blood pressure and cholesterol.  

NCSL continues to monitor state action for trends and policies as it relates to health disparities in the State Public Health Legislative Database. 

Aneesa Turbovsky is a policy analyst and Kendall Speer is a policy specialist with NCSL’s health program. 

Please note that NCSL takes no position on state legislation or laws mentioned in linked material, nor does NCSL endorse any third-party publications; resources are cited for informational purposes only.