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Community Health Saves Lives and Money

Posted By Prucia Buscell, Thursday, January 15, 2015

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

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. They say the results reinforce 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."

Tags:  buscell  community  complexity matters  health 

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