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Thursday Complexity Post
January 15, 2015

Community Health Saves Lives and Money


A 40 year community-wide effort to promote heart health and healthier habits in a rural low-income county in Maine has resulted in less illness, lower mortality, and millions of dollars in savings, according to a study published in the Journal of the American Medical Association. Authors believe the initiative can be widely adapted and that today's new data sources and technologies can make implementation even more feasible than when the program began in the 1970s.

Franklin County Court House

In the late 1960s community groups in Franklin County, which then had a population of about 22,000, identified cardiovascular disease prevention as a priority. A Community Action Agency and Rural Health Associates (RHA), a non profit medical group practice, which were both new at the time, coordinated their efforts with the community hospital. With the hospital's sponsorship, RHA established the Franklin Cardiovascular Health Program (FCHP), which targeted hypertension, cholesterol, smoking, diet and exercise. FCHP used county health data from the past decade as a baseline and compared Franklin with other Maine counties and state averages.


Dr. Daniel Onion, a MaineGeneral Health physician and one of the researchers, told Kaitlin Schroeder of the Kennebec Journal & Morning Sentinel the project was powered by volunteers who worked in the community to help people quit smoking and adopt other healthy behavior. An HPLive story by Gale Scott describes other details. Federal funds were used to start an insurance plan for 3,000 indigent residents. The University of Maine developed a health education degree program and trained local people to be outreach workers. Hundreds of volunteers, including 200 nurses, did health screenings and educated residents. Schools were persuaded to serve healthier meals. A health fitness center with the area's only indoor swimming pool was built with funds raised by the community. Over the years, 150,000 people had an average of five contacts each with a program worker.


A ScienceDaily story reports that between 1994 and 2006 lower than expected hospitalizations saved an estimated $5.4 million per year in hospital charges for Franklin County residents. The program, which continued through 2010, had many successes. Among people with hypertension there was a 24.7 increase in the portion of people in control of their blood pressure. Control of cholesterol increased 28.5 percent. The quit rate for smoking improved from 48.5 percent to 69.5 percent. The overall death rate and the cardiovascular death rate dropped below state levels during most of the study period.


Darwin R. Labarthe, MD, MPH, PhD, and Jerome Stamler, MD, of the Northwestern University Feinberg School of Medicine in Chicago say in a JAMA editorial that the Franklin County experience deserves to be examined and copied. The results, they say, reinforce the importance of disease prevention at the local level. They call on communities to document and publish past experiences in community health to "inform ongoing work and foster wider application of program evaluation and implementation research, exploiting new data sources and technologies to accelerate replication and scaling up of community-based prevention. Intervening developments-not least among them the Affordable Care Act-have made this task clearly more achievable today."


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Healthcare PlexusCalls

Wednesday, January 21, 2015  1:00PM Eastern

Embracing Complexity: Managing Treatment-Related Symptoms During and After Cancer Treatments
Guests: Noah Zanville, Sarah Shockley and Christine Cote                   


Cancer remains a leading cause of death for individuals in the U.S., but has increasingly become a disease patients can survive, thanks to a growing arsenal of effective treatments. For patients today, this arsenal includes cutting-edge surgery, hormone therapy, chemotherapy, radiation therapy, biologics and immune-modulating drugs. Together, this collection of treatments is helping more and more patients to fight, and win, their battle against cancer. Unfortunately, many of these treatments can also lead to side-effects that can disrupt patient's transition back to wellness and, in some cases, threaten their ability to finish their cancer treatment. This tension between treatments that heal and treatments that harm is a major theme in oncology, and is made worse by the fact that in many cases, there are no treatments for these side-effects. Social factors like an aging population, increasing pressure to stay in the workforce and spiraling healthcare costs further underscore the need to help patients, their families, and their providers to manage treatment-related symptoms during and after cancer treatment.

Noah, Sarah and Christine will join the call for a roundtable conversation about the challenges of cancer treatment and what "embracing a complexity perspective" might look like in the everyday care of cancer patients. Please bring your voice and your own experience to this important conversation. Read the guests complete bios.      




Friday, January 23, 2015  1:00PM Eastern

Death by Distrust: Rumor and Reality in Fighting Ebola
Guests: Helen Epstein and John Townsend                    


Helen Epstein, PhD, wrote a recent article in the New York Review of Books entitled Ebola: An Epidemic of Rumors. In researching the disease in Liberia, she found that part of problem causing the disastrous spread was political, which resulted in poor communication and false and misinterpreted information.
Helen Epstein's articles on public health have appeared in The New York Review of Books, The New York Times Magazine, The Lancet, The Washington Post, The Times Literary Supplement, and other publications. She has worked as a consultant for such organizations as the World Bank, UNICEF and Human Rights Watch. She is the author of The Invisible Cure: Why We Are Losing the Fight against AIDS in Africa (Picador 2008), which was chosen as a New York Times Notable Book and's best science book of the year. Since 2010 she has been Visiting Professor of Human Rights and Global Public Health at Bard College in Annandale, NY.
Dr. Epstein earned a BA at the University of California, Berkeley, a PhD at Cambridge University, and an MSc degree at the London School of Hygiene and Tropical Medicine. Dr. Epstein has been adviser to numerous international organizations on HIV prevention and a consultant on public health in developing countries to UNICEF, World Bank, Human Rights Watch, and other organizations.
John Townsend, PhD, is a vice president and director of the Population Council's Reproductive Health program. He provides leadership, directs research and advances policy innovations on family planning practices worldwide. He oversees research on basic biomedical studies, development of contraceptives, and social science research to identify causes of reproductive health outcomes. He also researches development, scale-up, financing, and sustainability of service delivery models. He works with international health and development agencies, ministries of health, and private healthcare providers to implement policies and programs that encourage more effective healthcare practices. Dr. Townsend joined the Council in 1984. He was director of the Frontiers in Reproductive Health program; director of operations research programs in Asia and the Near East (1993-1998); regional director for Latin America and the Caribbean in Mexico (1990-1993); director of operations research in Latin America and the Caribbean (1985-1990); and country director for the Council's Colombia office (1984). In each of these roles, he designed and tested interventions that improved the coverage, quality, and sustainability of reproductive health service delivery systems.



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