Inspiring Health at the Community Level - Esther Dyson, Executive Founder of Wellville

It's a pleasure.

So I'm pretty old. I've had a long career. My parents were both scientists, a mathematician and a physicist. So, I was always curious about things and worked for my high school newspaper and then my college paper and ultimately became a factchecker and reporter for Forbes magazine. So, my superpower is asking questions and that's pretty good training for just about anything. While I was at Forbes, I got interested in tech and ultimately moved to Wall Street for five years where I followed some tech companies including Cray Research, which was one of the very first supercomputers and also somewhat randomly a little startup called Federal Express. So I've also had an abiding interest in logistics and then I joined this guy who had a technology newsletter called the Rosen research letter or something like that. And then for 25 years I ran the newsletter and its annual conference and was the court jester on the scene watching the development. Our speakers included Bill Gates and Steve Jobs and later on Reed Hoffman and this guy Mark Zuckerberg. So I watched the whole thing emerge and ultimately sold it and became an angel investor trained as a cosmonaut. Then began to get interested in healthcare and asked the fundamental question you've got to ask if you look at healthcare. Why do we spend so much money and effort fixing things that shouldn't have been broken in the first place? I thought somebody should just do a health X-Prize and I was going to give a talk saying that and realized that would be a terrible talk. So I decided to announce that I was going to run what would initially we thought of as a contest for five communities. Not five healthcare outfits but actually the people in five communities to make the greatest improvement in their communities over five years with five metrics. And one of the privileges of starting something yourself, and I ended up funding it myself, too, is just like with a startup, you get to pivot. So, it ended up being a 10-year project. I hired a CEO because I've seen so many founders destroy the things they love when there's nobody there to tell them, 'Hey, dude, listen, make sense.' So this wonderful partnership with our CEO Rick Brush and we are now in year six of the 10-year project that ends in 2024.

It is most definitely not a nice lady from New York is here to fix you with her programs and her technology. We're basically a coaching organization. There's only seven of us. Five of us each has one of the communities where we've at least until recently show up once a month. And like a coach, we don't play the game. We coach the people who do and they own it. So metaphorically, we're not giving them fish. We're not teaching them how to fish. We're helping them to build their own fishing schools. And that kind of long-term change where you're actually improving people's lives from the start, ideally working with kids, takes a long time, which is why 10 years is necessary rather than a luxury. So each community is different. They're all under 200,000 people. The whole idea when we started back in 2013-2014 we put out a call for applications. You had to be under 200,000 people. You had to have some kind of cross-sector collaborative and you had to have a community that was a discrete community. People lived there, worked there. They weren't commuting in and out and they sort of felt this was their home. And so you could address the community rather than for example a population of people with a certain kind of cancer or some subset. And we were looking not just for diversity within the communities but diversity across the communities. So it wasn't the best five but the best group of five from which you can learn in a sense. To our amazement we got 42 communities that applied. So in the summer of 2014, Rick Brush and I spent most of it visiting 10 of the communities and ultimately picked five. So that's how it all started. And of course, we thought we'd have these five metrics and everything would be orderly. And of course, it wasn't like that at all. It's much more like raising children than building a barn. And we just got to work trying to be useful. And we've learned, as you can imagine, a whole lot. And our goal ultimately is to help the communities with their goal, which is to become healthier and more equitable places, but also not to scale by doing more communities, but to scale by inspiring other communities to do the same thing. We applied to the MacArthur Foundation for one of their amazing grants and of course didn't get it, but it was a useful process. And one question they asked was why are you so special? What are your backgrounds? The usual we want the bios. And in a sense, the better we are, the less valid our mission is because our fundamental premise is you can do it for yourselves. You don't need a bunch of outsiders. You can develop your own community affordances. You can have your own parents connect better through the schools. You know, this has to be done by the community. It can't be done by a bunch of benevolent outsiders who show up for two years and then leave. And as you can imagine, a lot of people in the communities were very skeptical. Yeah, we've had people come in before and tell us what to do and they paid us to do it and then when they left, it was over. So, we're trying to help them build this for themselves and that's tremendously satisfying and not a very quick thing to do. But we're beginning to see these different institutions emerge. We're beginning to see people think more ambitiously and more accountably. And you know, I was just in Muskegon and I can tell you a little more about that. It's not easy, but people want things to be better and if you help them believe in themselves, they can be.

I will do that with pleasure, but I have to put a whole lot of caveats on the beginning. The reason I'm thinking about it so much is that I'm in the middle of editing our study proposal for, you know, what amounts to a non-clinical trial that we're presenting to Abbott this week or next, asking for glucose monitors for probably on the order of 40 to 50 kids. And the way it started was diabetes is a huge problem in our communities as it is across the country. And I kept on thinking, you know what I'd love to do is give every second grader a continuous glucose monitor because second graders are really curious. They'd love to see this stuff and it's just so much more interesting than some kind of textbook. And second graders don't actually learn about blood glucose anyway. So that was just one of my crazy ideas, which as I mentioned is why we have a CEO who is a little more sensible. But then I was at the Boys and Girls Club in Muskegon and I saw one room where the kids were making presentations to one another. Another they were drawing and doing art and those were both great. And then in the third room they were watching a video and falling asleep and the video was a science video and that continuous glucose monitor idea came up again. And I thought, hm, long story, talked to somebody at Abbott, they said, 'Oh, no, we can't support off-label use.' And then the guy who does their studies said, 'Well, actually, we can because on-label use, it's no longer a study. It's just sales. But off-label use, that's what we want to learn about.' So, the basic idea is give the kids four weeks, the monitors last two weeks, four weeks, two Libre monitors a piece, and of course bears in case something goes wrong and so forth and so on. And we've assembled a bunch of people in this geek who will actually do this. It's hosted at the Boys and Girls Club. There's a local doctor called Dr. Wallace who will lead the course and do the curriculum. She's very much a public health healthy living as opposed to I'm just going to fill you up with medicines. Loves children and is actually now in an academic position at the Striker School of Medicine. So, she'll be the principal investigator and be leading this year-long course because after the four weeks, then they continue to learn in a group setting with Dr. Wallace and various other people coming in, not just about your blood glucose, but about how your body reacts to stress as well as food, how your metabolism works, your physiology overall, how you differ from other kids. Not everybody reacts the same to rice or bananas or smoked salmon or whatever. And also learning about how to read a food label, how to compare two grams of protein versus five grams of fat and eight grams of protein versus 20 grams of fat or whatever it is. But what makes this so much more interesting is that it's not stuff out of a book that feels irrelevant, but rather you get to be one of the kids in this really interesting class with a special device, which most kids don't have. And these generally are not the kids that usually get that privilege. So, it's designed to make them feel important and special, not extraordinary, but just like, you know, hey, you matter and to learn about themselves, to learn about how the food system works, how the profit motive makes companies market stuff to them that may not be good for them. And then in June, they get another two-week stretch with the continuous glucose monitor and see if their eating behaviors or their blood sugar has changed. But we also want to see what they've learned where we'll be asking what impact it's had on their family and how their family eats together and so forth and so on. And frankly, my hope is 10 years from now, some kid will come up to me and say, 'Hey, I'm a med student and I was in that course and this changed my life.' So that's kind of this is not what we're doing in every community. It just kind of emerged because Boys and Girls Club was there and Dr. Wallace and all these other things. But it's the kind of thing that I think this is how education should work. It's people who are curious and who learn from the reality around them, not just from the books, and who get help in understanding how the world actually works, which gives them a sense of agency. And who knows what happens next.

Most of this health advice, you don't see the immediate impact. I mean, your blood glucose doesn't go up in 2 minutes, but half an hour later, you can see the impact of what you ate or, you know, I tripped and broke my ankle recently, and my blood sugar level was considerably higher because of all the stress. So, you can see that, and it just makes it more real. But again, caveat, we still haven't gotten the approval from Abbott. So maybe by the time this podcast comes out you can add an epilog or something but that is our plan.