The Way to Wellville – A Bold Plan to Create Health in Five Underserved Communities

By Kelly Close and Adam Brown

Through a new non-profit called the Health Initiative Coordinating Council (HICCup), investor and entrepreneur Esther Dyson is bringing a Silicon Valley perspective to healthcare. In a collaborative effort titled “The Way to Wellville,” HICCup hopes to aid communities with issues like diabetes and obesity, substance abuse, mental health, and lack of access to care by rethinking the way healthcare is addressed. The five-year program gives five underserved communities expert advice and help with data collection and analysis to make improvements on health, economic, and environmental goals.

The five communities (Clatsop County, OR; Muskegon County, MI; Lake County, CA; Niagara Falls, NY; and Spartanburg, SC) were chosen in August of 2014 from ten finalists and 42 initial applications from communities in 26 states. All have less than 200,000 people and face significant challenges in health and financial resources. 

Way to Wellville wants to go far beyond small-scale pilots by helping communities apply well-known, proven approaches but in a way that is accountable, measurable, and ultimately fundable – things like changes in the food supply, early childhood eduation, and better use of technology to deliver care. Ultimately, communities will need to spend $15-$50 million apiece to make the big changes needed, but the hope is that they will later produce cost savings and productivity improvements greater than those initial investments. HICCup will link them with investors interested in social impact investing. Current partners include ReThink Health and Care Message, and more are in the works.

What is the ultimate goal? Aside from improving these communities, HICCup anticipates that the Wellville Five will serve as examples and inspirations to other, larger communities (“Supersize What Works,” notes Ms. Dyson’s great blog post).

Our Q&A with HICCup Founder Esther Dyson

Q: What are the biggest misconceptions about what you’re doing?

A: That Esther Dyson is bringing tech and wearables to the masses. What we’re really doing is quite different, and it involves local institutions. To go back to the old “don’t give a man a fish; teach him how to fish for himself” notion: We are in the business of helping the communities to build their own fishing schools so that their entire population can learn how to fish (and to build new schools), generation after generation.

Q: For addressing obesity and diabetes, what organizations are involved and what efforts are being implemented?

A: By design, the Wellville communities are rallying the collective assets of multiple stakeholders to address the upstream (before disease occurs) and downstream (after disease occurs) factors driving the obesity and diabetes epidemics. Downstream collaboration includes coordinated care among health systems and health insurers, employer clinics and health coaches, and education and counseling provided by public health and community agencies such as the YMCA, as well as (potentially) companies such as Newtopia and Omada Health.

Upstream collaboration focuses on long-term, sustainable changes to social, economic and environmental conditions – such as food systems, built environment and culture – to reduce stress and make the healthy choice the easy choice.

Q: How can diabetes/obesity organizations best get involved in Way to Wellville?

A: Each Wellville community has a coalition and a local lead. Write to us and we’ll refer you!

Q: What companies and organizations do you dream about getting involved?

A: The big food companies; they are a key player. They are not the enemy; they are potential allies with the scale and distribution capacity that will be needed to scale beyond the Wellville Five. Also, we want to work with pharmaceutical companies to make their medicines more effective, with companies such as Healogics (a major provider of wound care services), caregiver organizations, and many other companies that can help to produce health. Also, we’d love to work with companies that can offer small dinner plates, sports equipment, and the like. 

Q: What has been accomplished in these communities so far? What’s left to be done?

A: Almost everything still remains to be done; it takes a while for communities to develop the necessary teamwork and culture of accountability. The five-year Way to Wellville challenge began in January 2015. Much of this first year has focused on building the local leadership teams and plans for long-term success. Each community has launched a number of programs addressing a variety of issues – from flu shots to adverse childhood experiences. They will report on the impact of these initiatives as results become available.

Q: After the five-year timeline, what’s next? What are the next steps to scaling this up? How will HICCup be involved?

A: We hope that many other communities will steal our ideas…and that what Wellville can do in its small communities through collective action (such as promoting vegetables and reducing the cost advantages of unhealthy food), may end up being done through “government interference” more broadly. Our goal is to become unnecessary. 

Appendix: The Wellville Five

Each community has its own five-year health objectives that focus on “upstream” factors that matter to health, such as food systems, housing, employment, and social connections, as well as outcomes such as obesity rates and high school graduation rates. More specifics on the communities:  

• Clatsop County, OR. Population size: 37,000. The community is 92% white, 17% of children smoke, 16% of children and 26% of adults are obese, 66% of students graduate from high school, and 39% of residents live in rural areas. The main challenges are limited resources, difficulty coordinating healthcare, lack of employment opportunities, and food insecurity. Various stakeholders are working together to decrease chemical dependency, improve mental health, decrease the rate of obesity, create community partnerships, and support strategic planning on health needs, gaps, and innovation.

• Muskegon County, MI. Population size: 171,000. This community by Lake Michigan was formerly sustained by the lumbering and manufacturing industries but has encountered more difficult times for the past couple of decades. Its primary objectives are to decrease adult smoking (27% in 2014) and adult obesity (36% in 2014); to increase post-secondary degrees and credentials; and to improve social and emotional support systems. Muskegon County Public Health and the Rotary Club together are  leading these efforts.

• Lake County, CA. Population size: 65,000. The community surrounds Clear Lake, and has beautiful scenery but a difficult economic and health situation. In 2014, adult obesity stood at 46%, the unemployment rate was 15%, and 32% of children were living in poverty. The goals are to improve overall health and develop a wellness plan to address the most pressing issues, while also dealing with the aftermath of recent wildfires.

• Niagara Falls, NY. Population size: 50,000. Niagara Falls is a tourist hot-spot, and the economy centers on tourism and casinos. Here, 39% of children live in poverty, 21% of children are obese, 70% of students graduate from high school, 23% of adults smoke, and 30% of adults are obese. The objectives are to increase the availability of public transportation, housing, and jobs; increase active involvement and civic engagement; increase healthy behaviors; and reduce the rates of teen pregnancy, obesity, and chronic disease.

• Spartanburg, SC. Population size: 37,000. This is a diverse town whose economy for many years relied heavily on textiles and not enough on education. The children have suffered: 43% live in poverty, 24% smoke, and 16% are obese. As for adults, 15% are unemployed, heart disease stands at 42%, and one in eight (12%) have diabetes. The objectives are to improve access to care, reduce obesity, improve kindergarten readiness, and increase community pride. 

[Photo credit: http://www.hiccup.co/challenge]