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TRANSCRIPT: Nancy Brown, CEO of the American Heart Association, joins Denver Frederick for a conversation about the business of giving. (Aug. 28, 2016)Speaker 1:The following is a conversation between Nancy Brown, CEO of the American Heart Association, and Denver Frederick, host of The Business Of Giving on AM 970 The Answer in New York City.Denver:More than one in three American adults suffers from cardio vascular disease. To provide a little context, more women will die from heart disease this year than all the cancers combined. We Americans are fortunate that the person charged with leading the oldest and largest volunteer organization dedicated to fighting heart disease and stroke has created a culture of innovation, has forged some extraordinary partnerships and is increasing the amount of resources available to help better the lives of all Americans. She is Nancy Brown, the Chief Executive Officer of the American Heart Association. It is my pleasure to welcome her to The Business Of Giving. Good evening Nancy. Thanks for being with us this evening.Nancy:Good evening Denver. Thank you so much for the opportunity.Denver:Tell us about the American Heart Association, a little bit about your history and a bit more about the mission and objectives of the organization.Nancy:Absolutely, I'd be delighted to. As you've mentioned the American Heart Association is actually this world's oldest and largest voluntary health organization dedicated to fighting cardiovascular diseases and stroke. We've been in existence since 1924 and at the foundation of the American Heart Association's work is the scientific enterprise of the AHA coupled with our grassroots presence in communities throughout America and our presence in seventy international locations, where we dedicate our resources to help make the world a better place for people and to prevent heart disease and stroke. We are guided by the organization's 2020 strategic impact goal, which is to improve the cardiovascular health of all Americans by twenty percent by the year 2020 while reducing deaths from heart disease and stroke by twenty percent during that same time frame. This decade long goal really is the goal that is the guide post for the work of the organization.Denver:Let me ask you a little bit about heart attacks. I went around to a couple of my buddies this week and I said, "You know what a heart attack is exactly? How it differs from cardiac arrest?" I have to tell you Nancy, the answers were a little fuzzy, they were a bit uncertain. Give us an abbreviated heart disease 101 course if you would.Nancy:Sure, I'd be pleased to. Heart disease is as you said the country and the world's number one killer. Heart disease is eighty percent preventable. What happens when a person has a heart attack is that the arteries or vessels leading to the heart muscle generally become blocked. They become blocked from atherosclerosis, which happens as we age and also happens because of a hardening of arteries from individuals who have high blood pressure. When the arteries narrow or when the arteries are blocked due to atherosclerosis, the heart muscle is deprived oxygen therein causing the heart in some cases to have a heart attack. There's another kind of heart attack called a sudden cardiac arrest, which is actually not a heart attack at all. That is a misnomer. A sudden cardiac arrest happens when the electrical functions of the heart malfunction and a person's heart suddenly stops.Denver:Completely.Nancy:That person can be revived generally through CPR or through a defibrillator if one is available or if people are trained in CPR. We can come back and talk about the role the American Heart Association has played in that over time. The important thing if you're experiencing symptoms of a heart attack or symptoms of a stroke is to call 911 and get emergency care immediately.Denver:Are the symptoms different for a man and a woman?Nancy:Yes indeed they are. For men generally you know the classic heart attack, a man clutching his chest.Denver:That's right.Nancy:Generally what happens when either a man or woman is having a heart attack is that there is stiffness on the arms, a pressing on the chest, sweating, but women also have jaw pain that accompanies a heart attack for them often. Women can also have more nausea, vomiting and shortness of breath.Denver:What is a silent heart attack? I hear about them now and again. What is it? How do you know you've even had one? How common are they?Nancy:A silent heart attack is a heart attack just as I described before, where the heart is deprived of oxygen. Sometimes the symptoms are not as obvious. It might be a smaller heart attack, but in any case they are discovered often upon medical testing. People who don't go get emergency care right away in some cases, perhaps their heart attack is smaller and they don't have a devastating impact from having a heart attack, but the message here is that anyone who experiences the symptoms of a heart attack or of a stroke need to get emergency care immediately by calling 911 and getting to the emergency room. There are treatments now that were not available, things that can be done very quickly. For example with a stroke, a person having a blocked artery to their brain, they now can use TPA to dissolve the clot, and even now a clot retriever to remove the clot from a person's brain who is having a stroke.Denver:Time is of the essence. Don't be a hero and say, "I'll just tough this one out." Not a good way to go.Nancy:Absolutely. If there's someone in your family at risk of having a heart attack or stroke it's very important to know the warning signs, and it's very important to know CPR.Denver:Let's talk about a couple things that contribute to poor heart health. One of them would be sodium, or salt. How much more sodium or salt are we getting in the American diet compared to the guidelines that AHA recommend? Why does it raise your blood pressure?Nancy:The first thing to say about sodium is that the average American consumes thirty four hundred milligrams of sodium a day. The American Heart Association recommends that Americans consume no more than fifteen hundred milligrams a day.Denver:We're not even close.Nancy:The federal government's dietary guidelines suggest twenty four hundred milligrams a day, which we support because it's on that journey down from thirty four hundred milligrams. Most of the salt an individual eats is in packaged and processed foods. There are many hidden sources of salt, bread for example is a big hidden source of salt because many food product use salt as a preservative to allow longer shelf lives in food. This is why we support people eating whole grains, fresh fruits and vegetables. That's a much better road for people to go down.Denver:One of the things I've noticed having cut down on sodium is that it kind of kills the state of the food for about two days. You acclimate to it so quickly, you can't believe it. Actually you even get some taste from those foods without the sodium which are actually quite delightful.Nancy:Thank you for saying that. That's exactly how we feel about it. Again, if a person consumes more fresh, whole foods, the natural robust taste of vegetables and fruits and whole grains is really quite delightful without the taste of sodium getting in the way.Denver:Sodium makes everything taste a little bit the same, where the distinctive flavors come through when you don't have the sodium in there. I really was surprised to find that out. Another big issue of AHA that you've been on the forefront as well as our former mayor Mike Bloomberg, has been this big push against big soda. Boy there was a big victory recently in Philadelphia. Tell us about that and also some of the other strategies you have, trying to get Americans to drink less sugary soda.Nancy:Absolutely. Added sugar is a large contributor to obesity in this country. We were very pleased several weeks ago that the Food and Drug Administration has made clear their intentions for food labels moving forward to have to call out added sugars that are not naturally occurring in products. That will help consumers know and understand the amount of added sugar they're consuming. However, we know that youth especially get the largest percentage of their added sugar intake from sugary beverages. This is why for over a decade the American Heart Association has fought to reduce the availability of added sugar drinks for our youth. Most recently we have recognized that a taxation strategy that allows healthier beverages to be provided to people at less of a cost than those with added sugar would be a very important way for us to describe a differential that will make it more appealing to purchase the non added sugar drinks. Here's why this is important, especially as it relates to children and children's obesity.The average child in this country drinks their age in sugar sweetened beverages a week. If we look at what's happening in our country in terms of health statistics, the number of children who are overweight or obese is quite alarming. We see kids today in many states that are faced with diseases that used to be adult diseases, type 2 diabetes, high blood pressure. This comes from their lifestyle. We recognize at the American Heart Association that one of the most important things we can do is to try to change the environment around people, to give them a chance at a healthier life. As it relates to added sugars in particular we're especially concerned about the marketing of these unhealthy beverages to kids and to underserved minorities. This is a big focus of the association and one that we intend to really make a flagship of our public policy efforts.Denver:Are you making headway on that? Are companies beginning to get the message?Nancy:I think companies are absolutely getting the message.Denver:I do too.Nancy:If you look at how hard the beverage companies and their trade association fought the Philadelphia fight, and you see them gearing up. There are ten places right now that the American Heart Association and our partners are gearing up for ballot initiatives that will be prominent this fall. You see the American Beverage Association and the companies already, they're concerned. If they weren't concerned they wouldn't be expanding those resources. The one thing that I will mention that we are doing at the AHA, our board just approved in June a revised policy for our soda tax advocacy initiatives to focus where we can on a tiered tax structure, versus a flat tax structure.Denver:Very smart.Nancy:This tiered structure we believe will allow recognition for those products that have removed sugar, and we hope will encourage industry to reformulate products to be able to meet this lower tax threshold.Denver:Looking at childhood obesity, I think about thirty five percent of our children are either overweight or obese. How do we rank compared to the other developed nations in the world in that regard?Nancy:The United States of America has so much to be proud of, but when it comes to our health statistics we don't have as much to be proud of. We are not the healthiest country by far. As a matter the last survey I looked at from the World Health Organization of developed countries, in overall health we ranked sixteenth, or near the bottom of developed countries. That's really a problem, but it is also a rallying cry for the work that we do at the AHA. We must help people understand that their health is the asset that helps buy them everything else that's important to them in their life.Denver:You talked a few minutes ago about Impact 2020, the reduction of twenty percent across the board by the year 2020. We're a little bit more than half way through the decade, how are we doing Nancy?Nancy:On reductions in death rate we have achieved so far in this decade a fourteen percent reduction in deaths from cardiovascular diseases. What's especially interesting, because the AHA is focused not just on the general populations but on all Americans, we measure our progress in African Americans, in Hispanics and Caucasians, where there's data sources to support it, is that we've seen an especially promising reduction in deaths in African Americans and Hispanics, compared to what we saw the last decade. We're very pleased with this. This is forty three years of consecutive reductions in deaths from cardiovascular diseases in this country.Denver:That's great news that I think a lot of people don't appreciate.Nancy:It is great news. The problem as you've identified however is that we are not on track at this moment to achieve the twenty percent improvement in cardiovascular health as we've defined it. Just for your listeners, cardiovascular health is a combination of seven health factors and health behaviors.Denver:Life's Simple SevenNancy:Life's Simple Seven. These are health factors like your blood pressure, your blood cholesterol, your blood glucose. It includes your levels of physical activity, the fact that you don't smoke, your Body Mass Index and your health diet score. For us to see an improvement in cardiovascular health, all seven of those, and they're a bundled portfolio if you will, we have to see improvement in. We have much more work to do in these years leading up to 2020. This is why we have never worked harder in our work in public policy, in our work in inspiring and educating the public to care about their health.Denver:I think one of the great footnotes of all that was that forty nine percent of Americans think they have idea cardiovascular health when the number is actually ...Nancy:Fewer than one percent of all Americans.Denver:That tells you all about human beings that you need to know.Nancy:Absolutely, absolutely.Denver:I also like the way you try to reframe some issues. I think when we begin to speak to our health provider, that's a pretty negative framing. Why are you here today? What's wrong? Why are you feeling badly? You believe that if you can change that to a more positive framing we might get different outcomes. That's the strategy behind your branding campaign, Life Is Why. Tell us about that.Nancy:Life Is Why really is the centerpiece of all we do at the American Heart Association. Its intent and its purpose is to remind people that their health is their life and that the things that we can do are all about enjoying the things that matter most to people in their lives. When it comes to the healthcare provider in particular we believe strongly at the American Heart Association that this encounter should be about a physician or a healthcare provider talking to their patient about their life's aspiration and for that to be the dialog about how the physician and individual together can create a journey that allows that person to live their best life and the life that they desire. That's not what happens nowadays. We have a system very focused on problems and not about aspirations. We will continue to work hard to make sure that there are tools and resources and opportunities for that dialog to change.Denver:Yeah, I think aspirations are a better behavior change model than the other way around. Your tenure at the American Heart Association has really been marked by creating a culture of innovation. I might had that's not an easy thing to do in an organization that is ninety plus years old. Right at the heart of that, right at the center, very visible to everybody is AHA's innovation think tank. Tell us about that, the impact it has across the organization and some of your initiatives.Nancy:Sure, happy to do that. The think tank that we've assembled at the association is a group of volunteers that come from many aspects of professional life. There are doctors and researchers of course, but there are marketing executives, business executives, CEOs of health plans, people that know health policy and public policy. We bring in front of this group things we're thinking about and we ask for their ideas about how to make those concepts better.One example I can give you is that during the economic downturn of the 2008/2009 year, I talked to the think tank about the fact that we needed to diversify our revenue sources. We came up with four or five ideas of how we might take existing things that helped us meet the mission of the AHA that might produce a different kind of revenue model for the association. An easy one to talk about for example would be some enhancement we've made to our first aid and CPR programs at the AHA. The think tank really is a group of people that make ideas that we have better. They help us think about how to leverage relationships and how the AHA can be a catalyst for things related to science and technology and healthcare and consumerism.Denver:Along those lines last year you embarked upon what is perhaps the biggest investment you've ever made in the history of AHA around a program called One Team, One Vision. This is a fifty million dollar partnership between your organization and Google Life Sciences. Tell us about it.Nancy:Yes, actually that partnership has grown. It is now a seventy five million dollar research enterprise branded One Brave Idea. Here's the idea behind One Brave Idea, we believe that the scientific enterprise needs a new path forward. The average scientist who get NIH funding or funding from a research organization like the American Heart Association spends forty percent of their time writing grants for their continuation of funding or for a next source of funding. What we need to do is to find a cure for coronary heart disease, and we know that if the people who are conducting that research are focused on their research but also worried about where their funding is going to come from, that we weren't getting a hundred percent of their effort in the game. What we wanted to do was to find a way to take the question of funding out of the game.We wanted to simplify the process and create a more dynamic interactive research enterprise between the funding organizations and the selected scientists. Google Life Sciences now Verily subsidiary of Alphabet, AstraZeneca has come aboard and they've contributed twenty five million, as has Verily, as has the American Heart Association. We came together and on January fourteenth we gave a four week time frame for interested individuals who felt that they could come up with the cure for coronary heart disease to apply to be selected as the one leader with their vision. We left the application process open only for four weeks. In four weeks we had about three hundred and fifty people apply internationally.Denver:Crowd sourcing.Nancy:We've got it. We have a joint leadership group made up of executives of Verily, AstraZeneca and the AHA. We narrowed that group down to twenty six. We did interviews and got additional information from those folks. We narrowed it then down to ten and we held face to face interviews with the ten finalists at the end of June. In the coming weeks we will be announcing the selected recipient of the One Brave Idea of research enterprise who then, this individual and their extended team of people from throughout the world, will begin on their journey to find a cure for coronary heart disease. Now this team is interesting. It's not your traditional cardiovascular scientists, there are those folks on the team but there are mathematicians and people who know drug development and physics.Denver:A lot of cross-disciplinary people together, from all over the world I would imagine.Nancy:Absolutely.Denver:You have to call in and let us know who wins.Nancy:We will do that, for sure.Denver:Another initiative out of another entity you have there, you have something called the AHA CEO Round Table. You have a tremendous program around workplace wellness. Who are your partners and what are you trying to do with this endeavor?Nancy:Sure. About three years ago the American Heart Association created a CEO round table which today is twenty six CEOs of some of this country's largest and most influential organizations.Denver:Very impressive group.Nancy:Chaired by Henry Kravis, the co-CEO of KKR, and Terry Lundgren, the CEO of Macy's. The CEOs come together to share with each other challenges and opportunities, but the round table is really an incubator for new ideas of how to change the dynamic of health and engagement in the workplace. As I often say, we've been focusing on health in the workplace, "we," meaning society, for decades, but if you look around you most people in our workplaces suffer visibly from some of the risks for cardiovascular disease.Denver:Sitting around all day.Nancy:If we can create a new technology based way to inspire employees to care about their own health, if we can listen to the CEOs about what's important to them, we believe we can make a real difference. At the center of this effort is a new workplace health recognition and achievement program, where we've created an index that identifies both from measurable health outcome results as well as cultural activities around the company what are the most important things. We will be recognizing companies at a gold, silver and bronze level, and also identifying and recognizing America's healthiest companies by industry category and by size in this coming year. Those are all activities of the CEO round table.Denver:Great stuff. You have said Nancy that one of the biggest IT challenges that face the healthcare field is interoperability. That is a concept, or at least the word, that not many of us are familiar with. What is interoperability?Nancy:Interoperability is the ability for an individual's health records to be portable and to be transferred between and among any healthcare provider they might see. A person has generally several doctors that they might see, maybe they visited a hospital. In a perfect world, and there are so many people in this country working, including our federal government, to try to create the seamless sense that your records follow you where you go. Through this boon of electronic health records that is really being encouraged by variable reimbursement rates for doctors who have electronic health records, that this sense that your data follows you everywhere is, and should, both make a more accurate sense of a healthcare provider's interaction with a patient. It should reduce healthcare cost and unnecessary testing. It also should allow the patient really to be at the center of their healthcare information. That's really a big focus and something we work hard on through our advocacy [efforts 00:22:40].Denver:You mean I won't be getting that clipboard with the pen-thing to it and have to fill out the same information over and over again?Nancy:Hopefully there'll be an iPad that you can fill out or something to click on. This is really important for the future of healthcare in this country that we get this just right.Denver:You talked a little bit about fundraising before. In recent years that's become more and more critical to you because you have a very energetic agenda and it's all going to take a lot of money. What is your revenue model and what are some of your signature fundraising activities?Nancy:Sure, the AHA has a revenue model that includes of course largely philanthropic support. We are a 501-C3 philanthropic organization. Those dollars come to the association through events, through major gifts, through bequests and through gifts from foundation as an example.Denver:You've done a lot with major gifts from individuals, haven't you?Nancy:We have done a lot with major gifts from individuals. Our signature events bring in a good forty percent of the revenue of the association a year. In addition to that, as I mentioned earlier we've diversified our revenue. We have what we call mission aligned businesses that allow us to meet the mission of the association while also generating revenue. Our CPR and first aid training, which this past year generated about a hundred and forty million dollars in revenue to the association is one example of that.Denver:That's great. What are the challenges of leading a national organization? As you know there can be some tensions between national headquarters and the local chapters and the local affiliates. As a matter of fact that's been playing out in some major national health organizations of late. What are the keys to keeping the whole organization aligned and working together a common cause around the mission?Nancy:I couldn't be more proud of how aligned the American Heart Association is. I think that this is a result of a number of things. Probably first and foremost back in 1998 was when the association set its first decade long goal. That goal became a rallying cry for the entire association. Every component of the organization rallied together, aligned resources. We're a very congruent organization, all focused on the same activities, and we are one association. We previously had fifty six separately incorporated affiliates back in the nineties, but since 1998 we've been one corporate entity and there is great alignment, great passion, great camaraderie between the grassroots of the association, between the science of the association and between the national headquarters of the association. We're all working on the same thing and as I like to say, the most valuable assets that the AHA has is its science and its grassroots. Everything we do is meant to maximize our efforts in those areas.Denver:Talk a little bit more about that, AHA is a very special place to work. When people talk about the best nonprofit organizations in the country you're always on the list. As a matter of fact when they talk about health related organizations, whether they're for profit or nonprofit, you're always on that list as well, most recently in Fortune Magazine. As someone who's dedicated their entire life to good health, what is the key to creating and maintaining a healthy work culture?Nancy:I think at the American Heart Association people are very inspired by the work that we do. People have an opportunity to firsthand get involved in major and significant initiatives that are inspiring. At the center of everything we do we're saving lives.Denver:You're making a difference.Nancy:We can see the impact of our lives. We deal with patients in the public, we deal with families who've lost family members. This is very, very inspiring. I think the employees of our association get most of their energy from the fact that they get a chance to work with really amazing volunteers as well.Denver:Tell us about your website, the kind of information somebody will find when they go to it. Also maybe how people can get involved with AHA. Also if people want to make a contributor to financially support your work, what do they do?Nancy:Thank you for that. Individuals can visit the AHA's website at . On that website you'll find a variety of information that can allow you to live a healthier life. It also gives you great information about how to get involved locally. There's this terrific zip code finder, you can enter your zip code in and it will give you a sense of all the local activities, whether there are events or advocacy priorities or other programs of the association. Of course we would welcome anyone's donation at donate..Denver:Nancy Brown, the Chief Executive Officer of the American Heart Association, I want to thank you for being on the show this evening. You're a testimony to the importance of having leaders who are committed to pursuing a long term vision and not just short term needs. What you're doing at AHA is certainly evidence of that. It was a real pleasure to have you on the show.Nancy:Thank you so much. Thank you for the opportunity.Speaker 1:The Business Of Giving can be heard every Sunday evening between 6:00pm and 7:00pm eastern on AM 970 The Answer in New York and on iHeartRadio. You can follow us @BizOfGiv on Twitter and at businessofgiving. ................
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