Nearly 20 years ago I entered Family Medicine with a vision of shaping healthier individuals and communities. Over this time our disease based health care has devolved into a complex, disjointed, horribly expensive, and by current evidence often dangerous mix of medications, tests, specialists, shifting payers, and complex rules. Even the often discussed preventive care being discussed in think tanks is implying that the ticket to better health is dependant on the care (i.e. screening and exams) a health provider gives to an individual. This style of preventive care is at best early detection of something that may or may not cause you problems later; it is not true prevention. What is often surprising to the public is that the ritual annual “physical” has not been shown to save lives or decrease costs and that accepted screening tests (i.e. cholesterol, colonoscopy, PSA, pap smears, even mammograms) unfortunately are blunt tools at best and at worst lead to costly and painful interventions and treatments when applied broadly to well populations.
Without debate are the benefits of a comprehensive healthy lifestyle in societies throughout the world that share common practices. This is true prevention. Massive longitudinal studies have been carried out in thousands of patients over decades such as the Okinawa Centenarian Study, the HALE Project, the EPIC/Norfolk UK Study, the MacArthur Study of Successful Aging, and revolutionary studies performed by Ralph Paffenbarger (Harvard Alumni Study) and studies of the Cooper Institute. A recent book called the “Blue Zones” highlights several healthy populations throughout the world. When these populations migrate to become more modern they quickly adopt the health status not of their native lands, but of their new place of living. There is nothing new and innovative in these traditional lifestyles: they do moderate physical activity their entire life, eat a plant based diet, do not smoke, maintain their weight, some have a drink a day, and citizens give care forever. There is something magic about the elderly being weaved into their culture in a valuable and serving way, not left forgotten and at the mercy of a corps of medical providers. A perfect example is Clarice Morant who recently died at 104. She took care of 2 family members of equal age in her own home after the age of 100. Clarice gave care and received life and health.
So as the health care policy makers and interest groups debate over who will pay for the inefficient and costly care, maybe we need to give more thought into how we live and promote policies and programs that support an active and healthy lifestyle for all generations. Current health care reimbursement is compensated by how much care (i.e. tests, procedures, drugs, devices) we deliver; not by the thought, effort, and outcomes achieved. In our rural county of West Virginia have a project titled “Wild and Wonderful Trails for Every Child” which involves building a fitness trail and community garden at Elementary Schools in the county. Our first trail and garden is complete at Page Jackson Elementary School. We have a vision to reshape the built environment and nutritional policies to align with the principles of healthy living. Our focus extends the medical home into the medical home’s backyard with a collaboration of over 30 community partners all with common interest in preserving the health of our families and the environment we live in.
The grant activities will support accessible after school programs on the local trails to build family fitness, teach nutrition through “edible” gardens, and hopefully reattach children back to nature. The initiative will designate safe routes to school for walking and biking, gather and distribute donor bikes to put kids and bikes on these routes- and over time hopefully change the culture of how the community lives. The vision is a ring of trails initially focused around the school and expanding and connecting as the community sees the value not just in health, but in the aesthetic and economic impact a pedestrian and bike friendly community brings.
Also in line with changing the culture, we are also building a large event focused on community fitness for all- Freedom’s Run (www.freedomsrun.org). We are holding weekly fun runs and teaching classes to help all abilities succeed in their individual goals. The idea of all inclusive family “jogs” was first born in New Zealand under the legendary coach and mentor Author Lydiard (http://www.lydiardfoundation.org). Lydiard started the Auckland Joggers Club in the 1950’s mostly out of a desire to rehab heart attack victims (a wildly controversial concept at the time, now a standard of care). His Sunday morning gatherings of young, old, walkers, joggers, and a few serious runners became a weekly party. If you visit New Zealand today, similar groups gather in small towns throughout the country, and the health of the nation benefits in the active social play.
In 1962 the legendary University of Oregon coach (and Nike founder) Bill Bowerman traveled to New Zealand to observe Lydiard’s coaching technique for Olympic level athletes. What Bill really discovered though was the jogging movement of the citizens and came home to pen a 60 page pamphlet called “Jogging”, which quickly became a bestseller. A new word and lifestyle were born. Bill himself could barely cover a half mile the first day, but after several months of easy and fun running he was 30 pounds lighter, renewed, and could jog for miles. Bowerman began hosting Friday evening jogs in Eugene. First a few gathered but soon hundreds appeared at the Oregon track to head out on the local routes. Eugene is now recognized around the world for its trails, recreation, and community health. Bowerman started the culture change with the Friday jogs and expressed to the citizens “if you have a body you are an athlete”.
See YouTube videos of our fun runs and on Freedom’s Run itself. Our small county’s plan can be a model for any community, urban or rural. Perhaps the thought we put into this local initiative could be translated into a larger national forum….and maybe in the future we will be providing less care, like they do in Okinawa.