End the CV Literacy Crisis With a New Year's Resolution

Melissa Walton-Shirley


December 19, 2014

Every sixth-grader knows the basics of baseball, football, and soccer. Arenas are packed with fans that cry foul when a player is pushed during a basketball game and stadiums roar when a football is carried across the finish line. When asked to recite the Pledge of Allegiance children regurgitate perfectly what's been practiced daily since kindergarten. By age 18, most have a driver's license and have memorized the basic laws that govern the operation of a motor vehicle. Many have mastered parallel parking. They can reboot a computer and post to Facebook. But the basic information for self-preservation and detection and treatment of disease has been completely omitted from their early-, middle-, and secondary-education curriculum. When they are 60 years of age, many will suffer a stroke because they will believe that their blood pressures are "normal." They won't understand what it means when they can't breathe while lying flat. They will ignore signals that the rupture of an abdominal aortic aneurysm is imminent. Many among this generation will come into an emergency department with an ejection fraction of 25%, not because they missed the signs of a heart attack, but because they were never taught them.

High School CV Literacy Test

I proved what we already suspected last month. I partnered with a local education system to test over 200 high school students in rural America on basic cardiovascular information. I came away sorrowful but not shocked. I now have a keen understanding of why our healthcare system is broken.

The failures of our pitiful attempts as a nation to reform healthcare are blamed on greed, graft, and the never-ending war of philosophies that gridlock our two-party system. But the answers will not come from the political arena. They will come from our department of education. To prove that point, I'll share with you the results of just three of 22 questions that were given to students age 14 to 18.

Which of the following is a fat?

  1. Coconut oil (29% scored correctly).

  2. Broccoli.

  3. Cola.

  4. Water melon.

Excessive salt intake is related to:

  1. Dehydration.

  2. Fluid accumulation in the lungs (5% scored correctly).

  3. Low blood pressure.

  4. Cancer risk.

The death rate of a heart attack can be improved with:

  1. A CT scan of the chest.

  2. Blood-clotting agents.>

  3. Water pills.

  4. Aspirin (20% scored correctly).

  5. B and D.

The average score of 41% correct out of 22 questions tells us exactly why the very power source that drives our existence is vulnerable. Preventable ignorance has devastated our workforce, costs billions of life-years annually, negatively affects our quality of life, and drains our monetary resources. It explains why we don't understand how to embrace a $90 urgent-care visit to avoid a $90 000 hospital stay. Whether to go to an ER or a doctor's office is a crapshoot gambled thousands of times hourly in every corner of our nation. So what to do?

Educating the Next Generation

The concept is easy. The implementation is doable. The conversation is necessary. The process starts with kindergarten-level children who should advance with basic facts like, "How many rooms are there in your heart? What is blood? What does the heart do? How does the heart get blood?" As a student progresses, the level of sophistication of their understanding should increase to encompass basic pathophysiology, the negative effects of high blood pressure, and nearly all forms of acquired heart disease. They will recognize the signs of a deep vein thrombosis (DVT), make their parents seek medical attention before a devastating stroke occurs, and ultimately help their own children become health advocates.

I was told that education reform is a "huge chunk to chew," but surely it can't be more involved than the 6 years of hell we encountered trying to promote primary PCI without on-site surgery? Please Lord, let it meet with less pushback than the smoke-free Glasgow KY campaign, nestled in the heart of tobacco country. I bet I'll be disappointed, but I won't be deterred. I'll be told it will be too costly, but the task force necessary to help make these changes is "ready–made," short of assembly. It could consist of retired physicians, nurses, PAs, and RNPs who could assist educators with the massive overhaul. Every state should assimilate this task force, which would coordinate with retired computer programmers and educators. After a year, we could emerge with an education curriculum that decreases disease prevalence, improves longevity, and sharply affects the number of pharmaceuticals prescribed in our country.

Heart disease is a bipartisan, national issue, and we should insist on support from all aspects of the political arena. We are intelligent enough to do this, and we should be passionate enough to insist that it happen. I'll be accused of naiveté and oversimplification, but ignorance is bliss if it can spark a necessary interest.

We can continue our incessant conversation about the cost of caring for people who are difficult, noncompliant, psychiatrically unstable, addicted, or mentally handicapped, but this conversation is not about people we cannot easily help. This movement should focus on those whom we can easily help. With the delivery of repetitive progressive information and access to education tools, we can graduate a generation of students who possess enough knowledge to become elite health advocates.

So the next time we watch a high school senior cover their heart and recite the Pledge of Allegiance, think of how important it is to equip them with the necessary knowledge to prevent and detect the basic pathologies of the very organ that beats beneath their hand. I insist that we should also include information on topics like the signs of common maladies like appendicitis, gallbladder disease, and colon cancer and prevention of lung cancer, hip fracture, and breast cancer. Basic knowledge regarding prescription meds and over-the-counter pharmacology should be mandatory. With a revamping of our education curriculum, starting with kindergarten and for the duration of their 12-year odyssey, we could become number one in health literacy. The time to start building the most worthwhile legacy of our generation of healthcare providers is now.

Sounds like a good national New Year's resolution to me.

(To view the CV literacy exam in its entirety, please go to in January 2015.)


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