The Telltale Hearts

Is it possible for a city to completely eliminate heart attacks? New Ulm is trying.

The Telltale Hearts

On December 1, 2004, the city of New Ulm made headlines when the butter plant downtown exploded, melting three million pounds of golden goodness and sending a fragrant flow of molten ooze down Center Street and into the Minnesota River. As the fire spread, plumes of burning butter coated the city in a cholesterol glaze, and the cold December night slowly solidified the mess by the river into giant blobs of congealed animal fat.

The butter plant incident happened outside. But a mile away, at the New Ulm Medical Center, a similar catastrophe happens once or twice a week, inside residents of New Ulm—to people who smoke too much, eat gobs of saturated fat, and grease their arteries with liquid death. Roughly 80 people a year die from heart attacks in New Ulm, a city of 13,500 where more than half the population is either overweight or clinically obese, and the prevailing German predilection for the three Bs—beer, brats, and butter—is a distinct point of civic pride. Or at least it used to be.

A remarkable transformation has taken place in New Ulm over the past five years. In local restaurants, more salads accompany meals than fries do these days. Walkers and joggers are everywhere. Gym memberships have never been higher. The local farmers’ market is adding an extra day this year to meet the growing demand for fresh produce. Participation in locally organized 5K runs is regularly in the hundreds, and heart-healthy trends that Twin Citians take for granted—like walking and biking to work—are suddenly becoming fashionable.

Collectively, the citizens of New Ulm have lost more than 8,000 pounds in the past three years, and every measure of the town’s overall health—blood pressure, cholesterol levels, triglycerides, fruit and vegetable consumption, exercise levels, even the number of heart attacks—is improving. In fact, New Ulm—once home to the nation’s largest Velveeta factory—is well on its way to establishing itself as a national model for sustainable civic health.

How did a town full of belly-over-belt bratwurst lovers transform itself into a Midwestern haven of higher health consciousness? Not by accident.

An Impossible Goal

For 20 years, Dr. Kevin Graham, a cardiologist with the Minneapolis Heart Institute, made the 90-mile trip from the Twin Cities down Hwy. 212 through the Minnesota River Valley to the New Ulm Medical Center, where he helped patients fight the slow ravages of heart disease. Frustrated at being on the back end of the health care system, where tragedy is an all-too-frequent outcome—and knowing that heart disease is preventable in most cases—he started wondering how it might be possible to keep people out of his office altogether.


Coincidentally, New Ulm’s civic leaders had come to recognize that the health of New Ulm’s citizens was a problem that needed solving—somehow. The reason: The city is trying to expand everything but its waistline.

“It’s important for us to have a healthy workforce,” says New Ulm mayor Robert Beussman, whose own quadruple-bypass surgery four years ago was as scary as it was motivational. “Healthy workers mean local companies don’t have to spend as much on health care. Businesses interested in operating here are also more likely to do so if they know the workers they hire here are going to cost them less in the long run.”

Allina Health runs the New Ulm Medical Center and is one of the largest employers in town. Former Allina CEO Dick Pettingill shared Graham’s interest in the preventive aspect of health care, not only for his own workforce but also for the town of New Ulm in general. Together, they brainstormed a ridiculous, outlandish-sounding, probably impossible idea—and presented it to a steering committee of community leaders.

Their proposal: If the city of New Ulm had the money and resources to do so, could it completely eliminate heart attacks in 10 years? Or, at any rate, would it be willing to try?

The steering committee voted, and its answer was a resounding yes.

As soon as New Ulm accepted the challenge, Jackie Boucher, a dietician and education expert at the Minneapolis Heart Institute Foundation, got a memo from Graham, her boss, telling her that they needed a plan—and fast.

Now it was her turn to have a heart attack.

The problem: No one quite knows how to go about reducing, let alone eliminating, heart attacks in an entire city, and she only had one week to figure it out. Minnesota’s own Statewide Health Improvement Program targets diet and exercise, but its success is mostly anecdotal, told in stories more than statistics. Dozens of other programs around the country have tried to improve civic and/or cardiovascular health as well, but most have posted inconclusive results or, at best, seen only temporary gains.

“I studied other programs around the country and concluded that we had to do more than just tell people to eat better and exercise more,” says Boucher. Everyone already knows that anyway, she says. “The challenge is motivating them to do it and providing people with a supportive environment in which to make those kinds of lifestyle changes—and that requires a change in culture.”

Social researchers Nicholas A. Christakis and James H. Fowler are famous for a study they published in 2007 in the New England Journal of Medicine arguing that obesity is contagious. In short, they found that obese people tend to associate with each other, reinforce their excessive eating habits, and pick up and pass along bad habits from person to person like a disease. But in their latest book, Connected: The Surprising Power of Social Networks and How They Shape Our Lives, Christakis and Fowler argue that this same network-contagion principle can, in theory, be applied to influence social networks in positive ways, nudging people to quit smoking, say, or adopt healthier eating and exercise habits.

Applying this idea to the situation in New Ulm, Boucher figured that if she could get enough people—particularly obese people—to change their diet and exercise habits, and create a civic environment that supported and encouraged those changes, heart-healthy living might itself become contagious. A week later, the Heart of New Ulm project was born, and so began the city’s lifestyle revolution.