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Write a policy memo on the topic “Improving Access to Pediatric Specialists for All Children” using google scholar or https://pubmed.ncbi.nlm.nih.gov/ I have attached instructions and an example.
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To: Governor Brian Kemp
From: Caitlyn Brown
Re: Legislation for Decreasing Cardiovascular Disease Deaths in Georgia
Date: May 1, 2022
Problem Statement
Cardiovascular disease continues to be the leading cause of death in Georgia. Over the
past five years, the number of Georgians that die every year from cardiovascular disease has
increased. In 2020, there were 21,226 Georgians that died from cardiovascular disease[1].
Without action to bring awareness to cardiovascular disease prevention and care, more and more
Georgians will die every year. What can you, Governor Brian Kemp, do to decrease the number
of deaths caused by cardiovascular disease in Georgia?
Background
Cardiovascular disease is defined by the World Health Organization as a group of
disorders that affect the heart and blood vessels. It is the leading cause of death in the United
States. Cardiovascular disease represents 1 in every 4 deaths each year, with someone dying
from a cardiovascular related event every 60 seconds[2]. The state of Georgia is not immune
from the effects of cardiovascular disease. Every year there are 136,000 years of potential life
lost in Georgia due to cardiovascular disease[3]. These represent the number of years that people
who died of cardiovascular disease lost as a result of their death.
Some of the risk factors for cardiovascular disease include smoking, poor diet, high blood
pressure, high blood cholesterol, obesity, and physical inactivity[4]. All these risk factors are
preventable on the individual level with proper action and awareness. Previous studies have
shown that as much as 80% of heart attacks and strokes could be prevented by interventions that
reduce risk factors such as high cholesterol, smoking, and physical inactivity[5].
Currently, Georgia has some policies in place to prevent cardiovascular disease deaths.
One of these includes five different interventions to increase the effectiveness of public access
defibrillation (PAD)[6]. These interventions allow for better use of public AEDs and quicker
reaction times from emergency responders. These policies help decrease the number of people
who die after having a heart attack or stroke. While these policies are effective, they only help
after someone has had a cardiovascular disease related event and don’t prevent them from
occurring in the first place.
Options Analysis
The criteria being used to evaluate the options are cost, effectiveness, and administrative
ease. Cost evaluates how much this option will cost the Georgia government to implement.
Effectiveness evaluates how well this option will decrease the number of cardiovascular disease
deaths in Georgia. Administrative ease evaluates how easy this option will be able to implement.
Option one – Allow for Workplace Education About Risk Factors: Governor Brian Kemp
should encourage Georgia Congress to pass a law that allows for workplace education about
obesity, high blood pressure, high blood cholesterol, and diabetes prevention. This law would
allow companies to host education programs about some of the risk factors for cardiovascular
disease and warn against the effects they can have on an individual’s health. There are currently
many states with similar laws that allow for this type of workplace education. The CDC has
reported that these types of intervention programs have strong evidence for potential impact and
are based on high quality evidence[7]. Decreasing the prevalence of these important risk factors
will lower the number of people who have cardiovascular disease. This option would have a low
cost to the Georgia government. The workplace education would be provided by companies, so
there would not be a cost to the government. The effectiveness of this option would be high. As
stated, the CDC reported promising results from similar laws in other states. Studies have also
shown that the 44% of the decline in heart disease deaths from 1980 to 2000 was due to increases
in physical activity, reductions in smoking, and lowering cholesterol and blood pressure[5]. The
administrative ease of this option would be high. There most likely wouldn’t be any backlash
from this law, but some companies may choose not to provide the education programs.
Option two – Lower the Copayments for Antihypertensive Drugs on Medicaid: The
second option to reduce the number of deaths due to cardiovascular disease in Georgia is for
Governor Brian Kemp to push for the decrease of copayments for antihypertensive drugs on
Medicaid. This law would lower the how much a Medicaid patient must pay for antihypertensive
drugs. Currently, Georgia ranks as intermediate on the price of copayments for antihypertensive
drugs[8]. This is important because high copayments may deter low-income families from
getting treatment or getting diagnosed in the first place. Cardiovascular disease disproportionally
affects low-income families, which is what makes their availability on Medicaid important. In
Georgia, someone with an income lower than $25,000 per year is 10% more likely to have
hypertension than someone who makes over $75,000 per year[5]. This option would have a high
cost to the Georgia government because the state would have to provide funding to cover the
lower copayments. The effectiveness of this option would be high because it would decrease the
number of people with uncontrolled hypertension, which is a significant risk factor to death from
cardiovascular disease. The administrative ease of this option would be relatively low. The
policy might have a hard time getting approved because of the high cost.
Option three – Increase the Tobacco Tax: The third option to reduce the number of
cardiovascular disease deaths in Georgia is for Governor Brian Kemp to increase the tobacco tax.
Increasing the smoking tax will hopefully decrease the number of people who smoke in Georgia
because it will limit who is willing to pay for tobacco products. Smoking is a risk factor for
cardiovascular disease, so decreasing the number of people who smoke would decrease the
number of people with cardiovascular disease, and therefore would decrease the number of
deaths. Currently Georgia’s tobacco tax is $0.37 per pack, which ranks 46th in the US for the
tobacco tax price, with rank 1 being the highest tax[9]. The cost of this option would be low
because the tobacco users would be the ones paying for the taxes. The effectiveness of this
option would be moderate because it would influence the number of smokers in Georgia, but
those who are addicted will pay the higher price anyway. The administrative ease of this option
would be low because there would be a lot of backlash from tobacco companies that don’t want
to limit the number of customers that they have.
Recommendation
The best option for Governor Brian Kemp to take is option one. This option to allow for
workplace education programs about obesity, high blood pressure, high cholesterol, and diabetes,
has the best pros and cons, when compared to the other options. Table 1 outlines the cost,
effectiveness, and administrative ease of each of the options. The option with the lowest cost,
highest effectiveness, and highest administrative ease is option one. One of the concerns with
option one was that companies might not host the workplace education programs, which would
decrease the effectiveness of this option. In order to increase the number of companies that host
these programs, a tax incentive could be offered. While this would increase the cost of the
option, it would still have a relatively low cost when compared to how effective it would be.
Table 1
Cost
Effectiveness
Administrative Ease
Workplace
Education
Low
High
High
Decreasing
Copayments
High
High
Medium
Increasing Tobacco
Tax
Low
Medium
Low
Works Cited
1.
2.
3.
4.
5.
6.
7.
8.
9.
Heart Disease Mortality by State. February 25, 2022; Available from:
https://www.cdc.gov/nchs/pressroom/sosmap/heart_disease_mortality/heart_disease.
htm.
Heart and Stroke Statistics. Available from: https://www.heart.org/en/about-us/heartand-stroke-association-statistics.
Heart Disease. 2016; Available from: https://dph.georgia.gov/chronic-diseaseprevention/heartdisease#:~:text=Cardiovascular%20disease%20(CVD)%20is%20the,in%20Georgia%20du
e%20to%20CVD.
Cardiovascular diseases (CVDs). 2021; Available from: https://www.who.int/newsroom/fact-sheets/detail/cardiovascular-diseases-(cvds).
Public Health Impact: Cardiovascular Diseases. 2022; Available from:
https://www.americashealthrankings.org/explore/annual/measure/CVD/state/GA.
Public Access Defibrillation (PAD) State Law Fact Sheet. February 6, 2019; Available
from: https://www.cdc.gov/dhdsp/policy_resources/pad_slfs.htm.
What Could Be Addressed in an Evidence-Informed State Workplace Health Promotion
Law? 2017.
Prescription Drug Cost-Sharing and Antihypertensive Drug Access among State Medicaid
Fee for Service Plans, 2012. 2013, Centers for Disease Control. Division for Heart Disease
and Stroke Prevention.
Georgia: Tobacco Excise Taxes. Available from:
https://www.salestaxhandbook.com/georgia/tobacco.
Policy Memo Grading Rubric
NAME: ________________________________________________________________________
Overall (20 pts)
Memo identifies a specific and appropriate decision-maker. Writing is clear and concise. Memo is
readable and persuasive. Author uses correct syntax, grammar, capitalization, spelling, and formatting.
Citations are appropriate and consistently formatted. Tone is objective (not personal) and appropriate
for the document. The paper includes all required elements and follows the assigned format and page
length. Final version is submitted in Word file.
Problem Statement/Question Presented (10 pts)
Expectations: Problem is clearly defined, including relevance to decision-maker. Status quo is clear,
including what would happen if no action is taken. Question presented to the decision-maker for
analysis is clearly stated.
Background (20 pts)
Expectations: Memo contains all necessary information to understand the problem and the analysis of
each option. Memo does not contain extraneous or irrelevant information. Information presented is
accurate.
Options (40 pts)
Expectations: Memo identifies two/three appropriate criteria for evaluation and explains relevance of
selected criteria to the decision. Criteria are appropriate for the options and are defined if necessary.
Options considered address the problem as presented and would reasonably be considered by the
decision-maker. Options are sufficiently varied to represent reasonably different courses of action.
Analysis of options is consistent and balanced. (If doing nothing is an option, it is evaluated equally with
the other options.) Proposed actions are within the power of the decision-maker. Analysis of options by
criteria, including any ranking or scoring of the options, is reasonable based on the evidence presented.
Recommendation (10 pts)
Expectations: The recommended course of action addresses the problem as presented. Reasons for
choice are clear and only one option is recommended.
Grade: ____________/100
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