That said, one of the other reasons the Heart of New Ulm project is working so well—and a key factor that distinguishes it from other community-based health programs—is that it also provides counseling and support tailored for individuals. In fact, one of the main reasons New Ulm was chosen for the project is that 96 percent of its population uses one hospital, Allina’s New Ulm Medical Center. Because most of the city’s health records are contained in a single database, doctors, dieticians, and researchers can track the population’s health metrics—weight, blood pressure, cholesterol, etc.—and determine what effects, if any, their programs are having on people’s individual and collective health.
They also know if you’ve been bad. If a health screening reveals that you are clinically obese, have high blood pressure or cholesterol, or are otherwise at risk for what is known as metabolic syndrome, which puts you at higher risk for a heart attack, you will get an e-mail and/or personal call from a nurse or dietician. If you do not hang up on them, they will offer to work with you to develop a health-improvement plan that specifically addresses your needs. All for free.
Jane Soukup, a longtime resident of New Ulm, has been trying to lose weight most of her adult life. But nothing worked, she says, until she sat down with a dietician to discuss her eating and exercise habits. “I’d tried everything,” says Soukup. “My body has just always fought me.”
At her free consultation, Soukup learned that many of her lifelong eating habits had been shaped by myths about healthy eating she’d been misinformed about since childhood. “I grew up on a farm, and one of the things I’d always heard was that you shouldn’t eat after 6 pm.” And that’s how she lived, because even though she often went to bed hungry, she was afraid she’d gain even more weight if she snacked at night.
“The dietician asked me when I felt best in my life, and I told her it was when I was pregnant and eating every two hours,” Soukup recalls. “She recommended that I eat that way full-time, eat fewer carbs, bump up the vegetables, and—here’s the kicker—that I should eat a sandwich before going to bed.”
Soukup was surprised by that last piece of advice and didn’t think it would work, but it did. She’s lost 65 pounds in the past three years and is close to reaching her goal weight. “That sandwich made all the difference,” she says. “It turns out my body thought it was starving at night, and the sandwich kept my blood sugar and metabolism up.”
Everyone alive is at a different stage in the arc of their personal health, so this sort of one-on-one advice is crucial, both to the patient and the project in general. “In New Ulm, we have access to an extraordinary amount of data and permission to use it for outreach and intervention,” says Dr. Thomas Knickelbine, director of preventive cardiology at the Minneapolis Heart Institute and head research cardiologist for the project. “That’s huge,” he says, because most cities are served by multiple hospitals and health care networks, all of which use different computer systems, making it difficult to share patient information. Consequently, even if patients consent to share their personal health records, compiling data for entire city populations can be extremely difficult, if not impossible.
The Expensive Killer
Cardiovascular diseases cause one in three deaths in the United States, and heart attacks in New Ulm cost an average of $50,000 each to treat. Including indirect costs such as absent workdays, decreased productivity, and short-term disability, the total economic burden of heart attacks in New Ulm is estimated to be about $8 million annually, or $80 million over the course of a decade.
The goal, of course, is to eliminate heart attacks. But even if the Heart of New Ulm project can reduce the town’s rate of heart attacks by 25 percent in 10 years (in other words, prevent two additional heart attacks each year, relative to the previous year), it’s estimated the program will save $10 million over 10 years—about the same amount Allina is investing in it. The bonus prize is that the risk factors for a heart attack are the same for a host of other chronic diseases (diabetes, cancer, stroke, kidney disease, and perhaps even dementia), so a reduction in those areas could yield more savings—and, theoretically, improve the local economy.
Toward that end, the project appears to be working better and faster than anyone could have hoped. Blood pressures have dropped 4 percent, cholesterol levels have dropped 3 percent, and the average weight of New Ulm-ites has been trimmed from 184 pounds to 181. “A few percentage points may not sound like much,” says Knickelbine. “But to move the needle like that across an entire population, that’s significant.”
The number of heart attacks and deaths due to heart attack has also dropped—as much as 24 percent in one 15-month period—but researchers are reluctant to claim credit for this rather remarkable result until more data is on the books. The only blemish on the program so far is that folks appear unwilling to give up their cigarettes. “That’s one area where we haven’t had much success,” admits Knickelbine. “And it’s an important one, because smoking is one of the top three risk factors for a heart attack.”
One person who did stop smoking is Donna Oeltjenbruns. One of the biggest motivators for her was the fact that so many other people in town and at work were getting involved. “Everyone wants to be part of a group,” she says. “When you see a large group moving in a direction and you’re not moving in that direction with them, you feel left out. I might have dug in my heels at first, but then I got behind it.” Which is an excellent description of how social contagion works.
Pride and Permanence
The Heart of New Ulm project still has five years to go, and even the project’s leaders caution that 10 years of data, while nice, is only a beginning. Will the changes that are happening now be permanent? Can people keep the weight off? Will New Ulm’s next generation pick up the reformed diet and exercise habits of their parents and grandparents? Check back in 25 years.
For now, New Ulm is in the middle of one of the most interesting and potentially important social engineering projects in the country. And if it works in the long run, the project could have broad implications for those trying to grapple with the country’s runaway appetite for lousy food and increasingly expensive health care. Last year, the United States spent roughly $500 billion treating cardiovascular diseases and another $400 billion treating obesity and diabetes—costs that are projected to go nowhere but up unless people change the way they eat and live.
“We really want to be known as a healthy place to live,” says New Ulm mayor Robert Beussman, whose own bypass surgery happened on his wife’s birthday, of all days. “If we can prevent even one family from going through what mine had to, it’ll be worth it,” he says.
You can still get beer, brats, and butter in New Ulm, of course. But now you have to really want them—and at least consider going for a run afterward.