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Replacing short-term addiction with long-term purpose
Esther Dyson is no slouch when it comes to innovation.
The journalist-turned-entrepreneur-turned-investor has been overseeing her nonprofit project for the last 4-½ years, in hopes of laying a cultural foundation that embraces goals, and a long-term mindset. She and her team act as coaches and mentors to community leaders to help them realize their vision.
Esther joins us at our Dec. 13 salon, titled "Vitality: Lifestyle as a drug" since we know, barring severe health conditions, lifestyle interventions can have a far greater impact on our health than prescription medications.
Launched in 2014, the Wellville project’s goal is to show the value of investing in health, not in healthcare. But what started out as a five-year project expanded into 10 years as Esther grew comfortable enough to make the commitment of time and money to do the job properly.
“It’s about the parents and the children,” said Esther, when I asked her what’s been the biggest learning in the last few years. “We’ve become more focused on early childhood experiences and pre-and-postnatal care.” What was quickly apparent in these communities, she explained, was that many of the adults who had children lacked the resources to care for themselves, much less their kids.
“We want local community members to be trained to teach others to be better parents, better teachers, better counselors,” she said. “But we can’t do that for them. They have to to build these institutions for themselves.”
How Welville started…
Like many great endeavors, the idea germinated for some time. Back in 2007, Esther interviewed Charlie Silver, an entrepreneur who had sold RealAge, a health/supplement website, to Hearst and a car-maintenance chain to JiffyLube. Through her interaction with Charlie, it dawned on her that people take care of their cars better than they take care of themselves. She also realized that the return on investment for maintaining our health was actually higher than the return on repairing us when we’re sick.
After returning in 2009 from six months of cosmonaut training, she began thinking about healthcare in earnest. And in 2013, she decided to fund her project and partnered with Rick Brush as CEO. Rick was a perfect fit as he had led Cigna’s early efforts to engage with businesses and neighborhoods to improve social determinants of t health.
“I wanted to show that we as a society could invest in our human capital the way we invest in our infrastructure,” she said. To start, the team put a call for applications from communities of under 100,000 that wanted help in realizing their plans to improve community health. The small population would favor density over scale, on the theory that interacting institutions and density would allow relatively small efforts to have a big impact and “affect the whole community,” Esther explained. “We wanted the impact to be visible rather than something you could detect with regression analysis.”
That summer Esther and Rick and some advisors visited 10 of the applicants and chose five – “not the best five, but the best group of five. We wanted diversity within them and across them,” she said. The communities are: Clatsop County, Oregon; Lake County, California; Muskegon, Michigan; North Hartford, Connecticut and Spartanburg, South Carolina. (Niagara Falls was an early member, but dropped out by mutual consent.)
Each community has a coordinator from the Wellville team. Esther is the advisor for Muskegon.
“It’s like being a coach,” she said. “We’ll help communities figure out a business model , or what to buy, the way a coach might suggest gym equipment. But the client has to use the equipment for herself, In the end, we don’t give them fish; we don’t even teach them how to fish. We are helping them to build their own fishing schools for themselves.”
Some milestones achieved
“They’re still not as many numbers as I’d like,” Esther said. “It’s taken a long time to get things started. It’s not like you can just launch a program.”
But in some areas, such as Muskegon, Michigan, she is seeing a big uptake in people joining the Diabetes Prevention Program at the local YMCA due to referrals from local communities and churches, and a CDC grant via the Mercy Health System. Long-term, Esther sees the YMCA as a vector for spreading the learning from the Muskegon program to other Y’s across the country.
Other initiatives springing forth out of the communities Wellville is involved with include the building of five new city parks in Spartanburg and the opening of pre-school classes to 600 additional children in Clatsop County, Oregon.
What about technology?
The project is not about technology. “Everyone uses tech. We’re not adding that,” she said. “People think, ‘Oh Esther is bringing tech into these places.’ But people in Silicon Valley don’t get it. People don’t need tech; they need essentials, such as clothes or gas.
“Depression is not caused by a shortage of mental health apps,” she said. “Depression is caused by a crappy life, abusive parents.”
Next five years?
In the future, Esther hopes to see a baseline of improvements. “I want to see actual numbers being tracked. I want to see the food in the schools dramatically improve. The food is the hardest to change. It’s still too profitable to sell bad food.”
Another focus is early childhood. One of the best-known and validated programs in the field is Nurse-Family Partnership, which focuses on training nurses to support at-risk pregnant women with regular through visits, through to the end of the child’s second year. Esther would love to see such an approach implemented at scale, but it’s costly and complex to implement. (Medicaid will pay the cost of the nurse visits, but not of the training and other program elements.)
Spartanburg Regional Health System runs one such program, which has served more than 2000 mothers since 2008. Clatsop County is hoping to be part of a 16-county initiative in rural Oregon starting next year.
This program has shown more than at 5x return on investment over time. has shosaid Esther. “It’s focused on first-time, at-risk mothers with unhealthy circumstances and behavior. The ultimate return is visible in 20-30 years, but the immediate return is a reduction in pre-term births.”
In the long run, the children will matter the most. Will they have jobs? Will they graduate from high school and college and return to build their lives in their local town? This isn’t exactly what we would define as healthcare, but rather opportunity born from a solid foundation that starts with the family and trust inside that family.
That’s hard to pull off just four years in. But at least it’s getting started. Moreover, Esther does have this right: it’s not just about providing flu shots, but about helping families and communities embrace the right long-term mindset. It’s about helping kids learn about patience and the desire to see a future and to work toward it.
“Long-term desire is purpose,” said Esther. “Short-term desire is addiction.” In other words, short-term programs are just a quick fix. Wellville isn’t about that. It’s about achieving long-term results with a long-term purpose. “It’s about committing and achieving to an outcome that’s uncertain and not immediate.”
NOTE: Save the date, our next salon is on Vitality - Healthy lifestyle as a drug, a look at wellness and prevention and behavioral change as the prescription for better health. JOIN us on December 13 at HP's headquarter in Palo Alto. Get Early Bird tickets or become a member. Join Esther Dyson (Wellville), Munjal Shah (HealthIQ), Hemalee Patel (Crossover Health/Facebook and more).
(Image source: ncoinc)
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