Like just about every other non-profit focused on making the world a better place, Wellville applied for the MacArthur Foundation’s 100&Change grant. In the event we win the $100 million prize our plan is to invest it in our communities to help accelerate their work to make serious health change. While we know the money would make a big difference to our communities, we had more realistic expectations for our involvement in the competition. We found the application process itself worth the effort. It forced us to sharpen our focus, and it encouraged healthy debate among us. Beyond that, we believe the process will lead to broader exposure for Wellville, and our five communities.
Because we think there might be some interest in how we answered simple questions like “What problem are you trying to solve?” we’re going to publish our application here, in regular installments. Below is the fourth and final in the series.
Our approach is built on a system of interconnected partners. In addition to the evidence-based program providers, we have two other kinds of partners worth mentioning.
Within each community, we partner with multiple entities beyond the “designated leaders,” from health systems, public health and payers…to school administrators, jails, housing authorities, religious organizations and food-system leaders. Most important, we partner with residents at the center of this work. Residents are not merely recipients of health-improvement programs; they know their own needs and participate in creating solutions through ongoing community engagement, starting with efforts such as the multi-neighborhood listening campaign underway in Spartanburg. (Often we support residents in communicating effectively with those who want to “help” them without having asked what they want.)
Finally, on a national level, Wellville hopes to form additional partnerships, especially as the reach and impact of our work increases through additional funding. These likely new partnerships involve evaluation/learning, financial and systems modeling, financing, and communication/sharing of outcomes. But they may also cover work with food companies, insurance companies, commercial sports/health brands, and health systems such as Geisinger, which is running a similar program in Scranton, PA, one of the Greater Wellville communities.
The immediate beneficiaries of our work are the most vulnerable populations in the largely poor and rural/urban Wellville 5 communities. Our work benefits these populations by helping them generate collective investment and improvement in their own well-being, capacity and health, broadly defined.
But our long-term ambitions are much broader. We believe that the world does not lack for specific evidence of programs’ effectiveness, but rather inspiration and belief that approaches like ours can work broadly and systemically. The pieces work, but only in pilots and experiments and anecdotes. The communities we work in are somewhat special cases: They asked us in. They are small and their problems are relatively simple compared to those of giant cities or impoverished, badly governed countries.
But the basic message here is that health is a collective asset. It’s very hard to get it by yourself. By showing what small communities can do through collective action without too much legal overhead, we hope to inspire larger communities and policy-makers to make and fund the same kinds of changes at scale. But they need concrete examples of success. Providing those examples is our mission.
Our executive founder, Esther Dyson, had invested in several relevant companies (Omada Health, ProofPilot, Kurbo, Voxiva) before founding Way to Wellville in 2013, and now takes care to disclose those relationships and recuse herself from any Wellville decisions involving them.
Overall, we believe that sustainability requires collaboration among parties with complementary interests in the same goals. Those include businesses, who appropriately require a return (profit) on their investments, officials seeking re-election or re-appointment, and charities seeking public benefit. We seek to show that investment in health – whether by governments, philanthropies or companies/investors – can pay off in the long run. No particular company is key to our efforts, but we believe for-profit companies such as food producers and retailers, along with healthcare providers transitioning to accountable health cultivation, will be key to the changes we are seeking. Those changes may well include taxing/pricing policies that reflect the long-term costs of unhealthy food or other products in the prices of those products. For such policies to be implemented broadly, we believe, the public needs to see the results of simulating such policies, usually with local collective action or charitable financing.
Human Subjects Research
Wellville works at the population level, using evidence-based approaches to improve public health and community conditions that influence health. Evaluating these broad efforts typically involves secondary data – usually publicly available, aggregated or de-identified – collected by a source other than Wellville, such as County Health Rankings & Roadmaps, or a local public health entity, healthcare provider or insurance plan.
However, we will use institutional review boards (IRBs) where appropriate, such as specific programs in Wellville communities that collect data from or about individuals. If we are awarded scale-up funding through MacArthur’s 100&Change grant, we may create (or partner to create) a centralized IRB function. This would allow Wellville to develop and share “generalizable knowledge” through multi-community initiatives, while minimizing risk and maximizing transparency on behalf of the individuals engaged in Wellville health improvement efforts.
Overall, our goal is not experiments or research, but roll-outs and outcomes. In short, we are trying to produce examples, not science, to inform both programs and policy. For example, seat belt laws, tobacco taxes and (potentially) taxes on sugary drinks have, in conjunction with public service campaigns, proven remarkably effective at changing both public attitudes and private behaviors.
After a long career in the tech world, Esther Dyson slowly discovered that the most interesting problems were not actually technology, but in human development and motivation. She thought “someone” should demonstrate what it would look like if we actually applied approaches that are known to work – but at critical density throughout a community. That “someone” turned out to be Esther herself. Likewise, she did not search for her team; they found her. CEO Rick Brush had worked on the same problems for Cigna, found her and asked so many questions she hired him. Retired Marine Marvin Avilez was an advisor who advised so helpfully we hired him. Organizer Marya was a friend of Marvin’s who gave us fundraising advice. Jeff was a colleague of Rick’s. They all volunteered until we brought them in. This approach will change as we scale, but it got us to where we are.