Seeking “One Brave Idea” to End Heart Disease: Nancy Brown and The American Heart Association

Heart disease is the #1 killer in this country, but 80% of it is preventable, according to Nancy Brown, CEO of the American Heart Association. In this segment from The Business of Giving, Ms. Brown spells out the different programs of AHA devised to reduce death from heart disease and to improve the cardiovascular health of all Americans.

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Nancy Brown, Chief Executive Officer of The American Heart Association

Heart disease is the #1 killer in this country, but 80% of it is preventable, according to Nancy Brown, CEO of the American Heart Association. In this segment from The Business of Giving, Ms. Brown spells out the different programs of AHA devised to reduce death from heart disease and to improve the cardiovascular health of all Americans.

She also discusses how mission-aligned businesses of AHA are generating 9-figure revenues for the organization, and how they and their partners are using crowdsourcing to find “One Brave Idea” to find a cure for coronary disease. Finally, she shares the keys to alignment, passion and camaraderie in a national charity.
The following is a conversation between Nancy Brown, Chief Executive Officer of the American Heart Association and Denver Frederick, host of The Business of Giving on AM 970 The Answer in New York City. It has been edited for clarity.

Denver: More than one in three American adults suffers from cardiovascular disease. To provide a little context: more women will die from heart disease this year than from all the cancers combined. So, 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. In so doing, she has forged some extraordinary partnerships and is increasing the amount of resources available to help better the lives of all Americans. That leader is Nancy Brown, Chief Executive Officer of The American Heart Association, and it is my pleasure to welcome her to The Business of Giving. Good evening, Nancy, and thanks for being with us this evening.

Nancy: Good evening, Denver. Thank you so much for the opportunity.

Denver: So, tell us about the American Heart Association, a little about your history, and 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 the world’s oldest and largest voluntary health organization dedicated to fighting cardiovascular diseases and stroke. We’ve been in existence since 1924. 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 70 international locations. In these,  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 20% by the year 2020, while reducing deaths from heart disease and stroke by 20% during that same timeframe. So this decade-long goal really is the goal that is the guidepost for the work of the organization.

Denver: Let me ask you a bit about heart attacks. I went around to a couple of my buddies this week, and I said, “Do you know what a heart attack is exactly? How does it differ from cardiac arrest?”  I have to tell you, Nancy, the answers were a little fuzzy; they were a bit uncertain. So give us an abbreviated heart disease 101 course if you would.

Nancy: Sure! I’d be pleased to. So, heart disease is, as you said, the country’s and the world’s number one killer. Heart disease is 80% 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 in individuals who have high blood pressure. When the arteries narrow, or when the arteries are blocked due to atherosclerosis, the heart muscle is deprived of oxygen, therein causing the heart, in some cases, to have a heart attack. There is 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: And 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!


But the message is that anyone who experiences the symptoms of a heart attack… or of a stroke… needs to get emergency care immediately. Call 911. Get to the emergency room. There are treatments now that were not available before–things that can be done very quickly.


Denver: Are the symptoms different for men and women?

Nancy: Yes, indeed they are. For men, we think of the classic heart attack– a man clutching his chest. Generally, what happens when either a man or woman is having a heart attack is stiffness of the arms, pressure in the chest, sweating. But women also often have jaw pain that accompanies a heart attack, and can also have more nausea, vomiting and shortness of breath.

Denver: And what is” the silent heart attack?”  I hear about them now and then. What is it? How do you know you’ve even had one?  And 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. And it might be a smaller heart attack, but in any case they are often discovered upon medical testing. And people who don’t  get emergency care right away in some cases–perhaps their heart attack is smaller– don’t have a devastating impact from it.  But the message is that anyone who experiences the symptoms of a heart attack…or of a stroke… needs to get emergency care immediately.  Call 911. Get to the emergency room. There are treatments now that were not available before– 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.  There is even a clot retriever now to remove the clot from a person’s brain who is having a stroke.

Denver: So time is of the essence. Don’t be a hero and say, “I’ll just tough this one out.”

Nancy: Absolutely! And if there’s someone in your family at risk of having a heart attack or a stroke, it’s very important to know the warning signs.  And it’s very important to know CPR.


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: Let’s talk about a couple of things that contribute to poor heart health. One of them would be sodium, or salt. Now, how much more sodium are we getting in the American diet compared to the guidelines that AHA recommends?

Nancy: The first thing to say about sodium is that the average American consumes 3400 mg of sodium a day. The American Heart Association recommends that Americans consume no more than 1500 mg a day. And the Federal Government’s dietary guidelines suggests 2400 mg a day– which we support because it’s on that journey down from 3400 mg. Most of the salt an individual eats is in packaged and processed foods. And there are many hidden sources of salt. Bread, for example, is a big hidden source of salt. Many food products use salt as a preservative to allow longer shelf life for foods. So, 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: And one of the things I’ve noticed–having cut down on sodium–is that sodium covered some of the real taste of the food, taste that is actually quite delightful!

Nancy: Thank you for saying that! That’s exactly how we feel about it. 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.


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 recognized 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.


Denver: Another big issue of AHA –where you’ve been on the forefront, as was our former Mayor Michael Bloomberg–has been the push against big soda.  And boy, there was a big victory recently in Philadelphia. Tell us about that, and also about some of your other strategies to get Americans to drink less sugary soda.

Nancy: Absolutely! So, added sugar is a large contributor to obesity in this country. And we were very pleased that the Food and Drug Administration has made clear their intentions for food labels moving forward–to call out added sugars not naturally occurring in products. That will help consumers know and understand the amount of added sugar they are consuming.

However, we know that especially youth get the largest percentage of their added sugar intake from sugary beverages. And this is why for over a decade, the American Heart Association has fought to reduce the availability of added sugar drinks for our youth. And most recently, we have recognized that a taxation strategy that allows healthier beverages to be provided to people at less 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.

And 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 recognized 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 under-served 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. 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 10 places right now that the American Heart Association and our partners are gearing up for valid initiatives that will be prominent this Fall. You see the American Beverages Association and the companies are already concerned. And so, if they weren’t concerned, they wouldn’t be expending those resources. The one thing that I will mention that we are doing at 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. And this tiered structure, we believe, will allow recognition for those products that have removed sugar. We hope it will encourage industry to reformulate products to be able to meet this lower tax threshold.

Denver: Well, looking at childhood obesity, I think about 35% of our children are either overweight or obese.  How do we rank compared to the other developed nations in the world?

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 of fact, the last survey I looked at from the World Health Organization of developed countries– in overall health– we ranked 16th, or near the bottom of developed countries. And that’s really a problem, but it is also a rallying cry for the work that we do at 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 The 2020 Impact Goal:  the reduction of death rate by heart attacks and stroke, and improvement in cardiovascular health by 20% across the board, by the year 2020. We’re a little more than halfway through the decade…How are we doing, Nancy?

Nancy: Well, on reductions in death rate, we have achieved so far in this decade a 14% reduction in deaths from cardiovascular diseases. And what’s especially interesting– because AHA is focused not just on the general populations, but on all Americans…we measure our progress among African Americans, Hispanics and Caucasians where there are data sources to support it…We’ve seen an especially promising reduction in deaths among African Americans and Hispanics compared to what we saw the last decade. We’re very pleased with this.  This is 43 years of consecutive reductions in deaths from cardiovascular diseases in this country.

Denver: That’s great news, and I think a lot people don’t appreciate the progress made.

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 20% improvement in cardiovascular health as we’ve defined it. And just for your listeners, cardiovascular health is a combination of seven health factors and health behaviors.

Denver: Life’s  Simple Seven.

Nancy: Life’s Simple Seven. So, 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 healthy diet score. And so, for us to see an improvement in cardiovascular health, in all seven of those–and they’re kind of a bundled portfolio, if you will–we have to see improvement. And so, we have much more work to do in these years leading up to 2020. This is why we have never worked harder in public policy and in inspiring and educating the public to care about their health.

Denver: And I think one of the great footnotes of all this was that 49% of Americans think they have ideal cardiovascular health…when the number is actually…?

Nancy: Fewer than 1% 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, there is some negative framing:   “Why are you here today? What’s wrong? Why are you feeling badly?”  And you believe that if you can change it to a more positive framing, we might get different outcomes. That’s a 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. And its intent and purpose is to remind people that their health is their life.  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 a patient about his or her life’s aspiration.  The dialogue should be about how the physician and the individual– together– can create a journey that allows that person to live the best life that one desires. That’s not what happens now. We have a system very much 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 dialogue to change.


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 100% of their effort in the game. So, what we wanted to do is to find a way to take the question of funding out of the game.


Denver: Your tenure at the American Heart Association has really been marked by creating the culture of innovation.  I might add:  that’s not an easy thing to do in an organization that is 90+ years old. And right at the heart of that–right at the center–very visible to everybody is AHA’s innovation Think Tank. Tells us about that, the impact it  has across the organization, and about 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. And we bring in front of this group things we’re thinking about.  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  2008 – 2009,  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 AHA… to produce a different kind of revenue model for the Association. An easy one to talk about, for example, would be some enhancements we’ve made to our First Aid and CPR programs at AHA. And so, 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 AHA can be a catalyst for things related to science, technology, healthcare and consumerism.

Denver: Well, along those lines, last year,  you embarked upon what is perhaps the biggest investment you’ve ever made in the history of AHA: a program called “One Team. One Vision.”  This is a $50-million partnership between your organization and Google Life Sciences. Tell us how that has developed.

Nancy: Yes! That partnership has grown. It is now a $75 million research enterprise branded “One Brave Idea.”  And here’s the idea behind “One Brave Idea” : We believe that the scientific enterprise needs a new path forward. The average scientist who gets NIH funding, or funding from a research organization like the American Heart Association, spends 40% of their time writing grants for their continuation of funding or for a next source of funding. And what we need to do is to find a cure for coronary heart disease. 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 100% of their effort in the game. So, what we wanted to do is 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 scientist. Google Life Science is now Verily, a subsidiary of Alphabet. AstraZeneca has come aboard, and they’ve contributed $25 million, as has Verily, as has the American Heart Association. We came together on January 14th. We gave a four-week timeframe 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. And in four weeks, we had about 350 people apply internationally…

Denver: Crowdsourcing.

Nancy: You’ve got it. And then from that… we have a joint leadership group made up of executives of Verily, AstraZeneca and the AHA. We narrowed that group down to 26;  we did interviews and got additional information from those folks. We narrowed it then down to 10, and we held face-to-face interviews with the 10 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. Then this individual, and their extended team of people from throughout the world, will begin their journey to find a cure for coronary heart disease. Now, this team is interesting; it’s not your traditional cardiovascular scientist. There are those folks on the team, but there are mathematicians and people who know drug development and physics and…

Denver: A lot of cross- disciplinary people coming together from all over the world, I would imagine.

Nancy: Absolutely!

Denver: Well, you have to call in and let us know who wins.

Nancy: We will do that for sure!


Interoperability is the ability for an individual’s health records to be portable and to be transferred between and among any healthcare provider he or she might see.


Denver: Another initiative you have is something called the AHA CEO Round Table. And 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 has 26 CEOs of some of this country’s largest and most influential organizations, 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: And if we can create a new technology-based way to inspire employees to care about their own health, and if we can listen to the CEOs about what’s important to them, we believe we can make a real difference. And at the center of this effort is a new workplace health recognition and achievement program.  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. And 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 faces the healthcare field is interoperability. That is a concept, or at least a word, that not many of us are familiar with.  What is interoperability?

Nancy: Yes. Interoperability is the ability for an individual’s health records to be portable and to be transferred between and among any healthcare provider he or she might see. And so, a person has generally several doctors that they might see…maybe they’ve visited a hospital. In a perfect world–and many are working on this, including our federal government–your records would follow you seamlessly wherever you go. Through this boon of electronic health records– encouraged by variable reimbursement rates for doctors who have electronic health records– if your data follows you everywhere, it hopefully should more accurately indicate what a healthcare provider’s interaction is with a patient. It should also reduce healthcare costs and unnecessary testing. And it also should allow the patient to really be at the center of their healthcare information.

Denver: That’s great.

Nancy: So that’s really a big focus, and something we work hard on in our advocacy…

Denver: You mean, I won’t be getting that clipboard with the pen chained to it?  And have to fill out the same information over and over again?

Nancy: Well, hopefully there will be an iPad that you can fill out, or something to click on. But this is really important for the future of healthcare in this country… that we get this just right.

Denver: You talked a little about fundraising before. In recent years, it has become more and more critical to you because you have a very energetic agenda.  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 (c)(3) philanthropic organization. Those dollars come to the Association through events, major gifts, bequests, and gifts from foundations.

Denver: And 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 40% of the revenue of the Association every 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 in our CPR and First Aid training– which this past year generated about a $140 million in revenue to the Association. That’s one example.

Denver: 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 in common cause around the mission?

Nancy: I couldn’t be more proud of how aligned the American Heart Association is, and 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 are a very congruent organization; all focus on the same activities, and we are one Association. We previously had 56 separately incorporated affiliates back in the 90s. But since 1998, we’ve been one corporate entity.  

There is great alignment, great passion, great camaraderie between:  the grassroots of the Association, the science of the Association, and 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 have are its science and its grassroots.  Everything we do is meant to maximize our effort 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. And as matter of fact, when they talk about health-related organizations– whether they are for profit or nonprofit– you’re always on that list as well, most recently in Fortune Magazine. From someone who’s dedicated her 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 get involved firsthand in major and significant initiatives that are inspiring. At the center of everything we do, we’re saving lives.  We can see the impact of our lives. We deal with patients in the public, and we deal with families who’ve lost family members. This is very, very inspiring.  And 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 someone will find when visiting it. How can people get involved with AHA?   And also, if people want to make a contribution to financially support your work… What do they do?

Nancy: Well, thank you for that! So, if individuals can visit the AHA’s website http://www.heart.org, 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, and it will give a sense of all the local activities– whether they are events, or advocacy priorities, or other programs of the Association. And of course, we would welcome anyone’s donation at donate.heart.org.

Denver: Well, Nancy Brown, Chief Executive Officer of the American Heart Association, I want to thank you for being on the show this evening. You are 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.

Untitled

Nancy Brown, Chief Executive Officer of The American Heart Association and Denver Frederick, host of the Business of Giving


The Business of Giving can be heard every Sunday evening between 6 and 7 PM Eastern on AM 970 The Answer in New York and on I Heart Radio. You can follow us at bizofgive on twitter and at facebook.com/businessofgiving.

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