More about creating a "community of wellness"

In the department of what goes around comes around, it's hard to believe that about 13-17 years ago, public health issues and wellness were all I used to think about (today it's urban revitalization).

By Michael F. Jacobson, director of the Center for Science for the Public Interest, and Sarah Fritschner, then food editor of the Louisville Courier-Journal.

My first job in DC was for the Center for Science in the Public Interest, the nation's leading consumer group concerned with nutrition issues. At the time (and still) it had a strong alcohol policies project** focused more on broad advocacy and policy rather than the self-help curative focus of the average group concerned with alcoholism, and a developing Safe Food project. Unfortunately, I left before they became rich, after which salaries increased markedly (one of my ideas generates CSPI a couple million dollars a year), and they added more staff and other programs.

** With this project, I assisted in the publication of the report Marketing Disease to Hispanics and the video version of the report Marketing Booze to Blacks and why I still get involved from time to time in issues around the sale and marketing of alcohol products in distressed communties.

I learned a lot working there, and as I joke, it "helped" me become more strident in my advocacy approach. At the same time, I learned a lot about nutrition, food marketing, epidemiology, and the costs of risky health behaviors. I also began learning more about nonprofit marketing (although it was something I was into before), publishing, since after awhile I ended up managing the publishing division, and dealing with press and other public communications activities. Plus, because the bulk of CSPI's income comes from the publication of Nutrition Action Healthletter, I learned a great deal about direct marketing, as I participated in the marketing team for the newsletter.

This newsletter is the largest circulation nonprofit newsletter in North America. Why? Great direct marketing packages and an understanding (at least for this part of the organization) that you need to invest money first, in order to make money. The relaunch of this newsletter from a policy oriented newsletter to one focused on self-help nutrition eventually led to a circulation (membership) increase of 1000%.

One year we exhibited at the annual meeting of the Academy of Health Services Marketing, which is the health and hospital marketing division of the American Marketing Association. One of the sessions I went to was about affinity marketing (you know, airline miles, branded credit cards, etc.)

At that time, "affinity marketing" was just making its way into the hospital care system, and I attended a session about Jefferson Hospital in Philadelphia, and their wildly successful affinity marketing program targeting "the mature market." The Hospital System signed up 16,000 people within a year (this is from memory so the details may be off). They did this with great commercials showing a bulldozer working its way through a mountain of medical and insurance paperwork, making the point that if you joined, all this paperwork would be surmounted because of master records created for the affinity membership.

The presenter discussed in hard numbers how many more admissions and how much revenue had derived from the program. And he made a comment that perhaps they would need to expand their cardiac program, since the people their affinity program was targeting tended to have more heart attacks, especially as they aged.


I was appalled by this comment, and given that CSPI was/is all about prevention of chronic health conditions through changes in dietary and other lifestyle choices, I asked about the provision of health education and outreach sessions as part of their program.

He brushed it off, stating that wasn't part of what they were trying to accomplish.

Because, of course, that would cut down admissions. And hospitals are about providing care in hospital settings, not about creating healthy communities, and reducing the need for medical care to begin with.

After this, I decided to learn more about hospital history, and I learned that health insurance was created by a group of hospitals in the Appalachias, not because they were concerned about helping people stay healthy and reducing risk, but to regularize hospital income.

The legacy of this history is that health insurance programs are skewed to paying for hospital and doctor services, rather than working towards the creation and maintainance of healthy communities.

This is a lead in to why I am interested in health care issues, and why it comes up in the blog--because I think it's about making great places in all aspects, and that includes the physical health and well-being of all residents.

So, that's why I find current efforts in New York City to be of interest. This AP story discusses how Mayor Bloomberg is engaging health behavior as an important community issue, "Mayor Attacks NYC's Unhealthy Habits." Bloomberg is interested in public health. He donated millions of dollars to Johns Hopkins University's School of Public Health, which was renamed for Mr. Bloomberg. It's a different approach from that currently underway in DC.

From the article:

When Mayor Michael Bloomberg sat down to lunch with children during a school visit a few years ago, he was disgusted by the soggy, greasy fries and other junk on their plates. He pushed for a revamp of school menus and by the start of the next school year, fat-laden meals were being replaced by healthier versions.

That same year, 2003, the city began handing out free nicotine patches and Bloomberg won his crusade to outlaw smoking in bars and restaurants. Now the city is going after high-calorie foods in bodegas, restaurants and company cafeterias. Experts say Bloomberg - a bit of a health nut himself - has targeted unhealthy lifestyles unlike any other administration before him. "It's more aggressive than we've ever seen in the past," said Dr. Allan Rosenfield, dean of Columbia University's Mailman School of Public Health. "There's a willingness to take on unpopular but important issues."

Tthe new DC blog DC's Black Voices discusses the proposed National Capital Medical Center, in a manner with which I disagree, but it's an interesting perspective (see the blog entry from earlier in the week "Piling on the hospital issue").

Index Keywords: health-care-planning