A Population Health Success Story: From Rural Action to Global Vision
The town of New Ulm, Minnesota is known as the most German city in the U.S. with a heavy focus on its beer, butter, and bratwurst. Ethnically and geographically isolated in southwest Minnesota, it has become an interesting laboratory, of sorts, to experiment with healthcare programs focused on changing lifestyles by increasing activity, changing diets, and improving the rate of wellness screenings.
With a parks and recreation budget three times that of other communities their size, the city founders, in the mid-1800s, mandated parks every half mile to encourage lives of health and wellness. Unfortunately, those early investments weren’t sufficient for its modern day citizens to avoid the challenges of increasing heart disease, obesity, and diabetes that soon plagued them just as much as the general population.
Though this is one small town of under 14,000 residents, the news is significant. In fact, the Heart of New Ulm Project that has transformed the lifestyles of people here is poised to impact communities of every size across the nation.
Documentary to Debut at the 2016 Healthcare Analytics Summit
This population health success story is the subject of a new documentary film that’s screening at the 2016 Healthcare Analytics Summit.
In many ways, this small town experiment demonstrates marked progress against these diseases and becomes an important example of a community that has bucked national trends. If New Ulm’s healthcare programs continue as planned, it will be even closer to its audacious goal of eliminating heart disease. Eight years into its ten-year effort, the town is reaching its goals. For example, as a result of a single phone-based coaching program, 70 percent of participants with have improved cholesterol; there is a 30 percent increase in participants exercising at least 150 minutes every week, a 50 percent drop in smoking and a 94 percent medication adherence among participants. In an effort to propel this wave of wellness and fitness, community leaders have made it easy for people to safely walk and bike in their community. And the number of restaurants that have added menu choices like salads, fruits, and vegetables has doubled during the program.
The $10 million Heart of New Ulm Project is part of Hearts Beat Back, the population health improvement arm of the Minneapolis Heart Institute Foundation, which initiated this collaboration among residents and through partnerships with New Ulm Medical Center (a nonprofit medical and surgical hospital that is part of Allina Health), the Chamber of Commerce, local employers, churches, schools, local colleges, and Brown County Public Health.
The mission of Hearts Beat Back is to create a world without heart disease, one community at a time.
“It’s really inspiring to see how New Ulm residents, employers, leaders and New Ulm Medical Center have partnered together to help our community become healthier,” said Toby Freier, President of New Ulm Medical Center. “Hearts Beat Back: The Heart of New Ulm Project’s innovative approach to preventing heart attacks is something that we hope in the future will be successfully replicated in communities all across the country.”
Motivated to Succeed
What drove the initiative? The statistics:
- Heart attacks are the leading cause of death for both men and women in the U.S.
- The CDC Foundation estimates that by 2030, annual direct costs associated with cardiovascular disease will rise to more than $818 billion.
- About half of Americans (47%) have high blood pressure, high cholesterol, and/or smoke.
- Every 43 seconds, someone in the U.S. has a heart attack, yet heart attacks are largely preventable through healthier lifestyles.
- 67 percent of adults in the program communities were overweight or obese.
So New Ulm decided to change these statistics. The Heart of New Ulm is a 10-year population-based prevention demonstration project designed to reduce the number of heart attacks and modifiable heart disease risk factors in this rural community. Considering the difficult task of changing people’s lifestyles, the results have been nothing short of astounding:
- An increase in the percentage of the population with LDL cholesterol in the recommended range, from 68 percent (2008/09) to 72 percent (2012/13).
- An increase in the percentage of the population with blood pressure in the recommended range, from 79 percent (2008/09) to 86 percent (2012/13).
- 72 percent of people in New UIm now get 150 minutes a week of moderate exercise; up from 64 percent in 2009.
- 30 percent of people in New Ulm now eat five or more servings of fruit and vegetables a day, up from 16 percent in 2009.
- 36 percent of people in New Ulm now take a daily aspirin, up from 29 percent in 2009.
- Among those receiving phone coaching, those eating 5+ daily servings of fruits and vegetables increased 200 percent.
“This project is like a critical-mass bicycle ride. If you get enough bikes out there, they can take over the street,” said Dr. Charles Stephens, the former local Medical Director for the Heart of New Ulm Project.
Social Campaigns Drive Success
This critical mass has been achieved largely through the efforts that target different areas of the community where people live, work, and play:
- SWAP IT to DROP IT™: educates and encourages people to make heart-healthy eating choices. This includes one-hour educational tours led by registered dietitians at grocery stores.
- SWAP IT to ROCK IT: a program with local schools and sports organizations to make healthier concessions available at area sporting events. One element of this program uses pricing incentives, such as clementines priced less than candy at 50 cents, to encourage selection of healthier items.
- Restaurant Program: improves the availability, identification, and promotion of affordable, healthier foods in partnership with local restaurants. Participating restaurants receive consulting support, recipe analysis, staff training, and are awarded with bronze, silver, and gold achievement levels.
- Food Explorers: a school-based program that integrates nutrition into the core curriculum to promote healthy habits among children.
- Farmers Market Promotion Program: Expands the promotion of local produce along with community resources. Includes cooking demonstrations at the markets and cooking classes in local restaurants. Farmers Markets are often closed early now because produce is selling out.
- HeartBeat Connections: a phone coaching program that focuses on primary prevention of heart disease. 1,100 participants since 2010 who talk for 15 to 20 minutes with a professional health coach. 50 percent drop in smoking among participants and a 70 percent have improved cholesterol.
- Complete Streets: Project leaders created more opportunities for people to safely walk and bike in the community by improving streets, adding bike lanes, and removing parking. Use of crosswalks has doubled since before the street redesign.
- Worksite Wellness: Employers created worksite wellness programs. Before the program, only five out of the area’s largest 100 employers had a program. Now, almost 6,000 participants from 116 employers are involved in some level of wellness programming.
From Small Town to Everywhere
The overwhelming success of the Hearts Beat Back program has encouraged its spread far and wide. In its mission to “create a world without heart disease,” the program has been packaged to help other communities improve the health of their populations. It includes technical assistance, assessment, strategy and program design development, award-winning programs and services, and measurement support.
The documentary follows the mayor of New Ulm, members of the city council, doctors, and other public participants, as they reveal their 10-year journey to change the health of their entire community. It presents a unique healthcare success story through the eyes of patients, doctors, and other healthcare professionals in a model of exemplary healthcare transformation that’s certain to inspire and encourage.