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 second in the series.
The Problem Statement
Global sickening, like global warming, threatens our collective future. The immediate threat of chronic, preventable disease affects our bodies and minds, eventually spreading across the society and economy those bodies and minds comprise. Like global warming, it’s everyone’s problem even though its immediate impact is uneven. In the long term we all suffer when those around us get sick, become unproductive or socially contagious (committing crimes and disrupting families) and require costly remedial care.
The formal knowledge to solve the problem exists, but the will and incentives to apply it are lacking. Indeed, there are financial incentives to sell things that make people sick, either directly or as a side effect, from (too much or unhealthy) food, to legal and illegal drugs, distracting/addictive online entertainment, tobacco and liquor.
Beyond those perverse incentives, the two primary challenges are short-term thinking, and the disconnect between investors in health (such as employers, insurance companies, schools and child-care organizations, transportation systems, food suppliers, healthcare providers) and the perceived beneficiaries – people without time or money (or capacity) to care for their own health. The returns to health investments do not always “return” to the investors, and it may be hard to determine which investment led to a good outcome.
Moreover, even institutions that could help (governments and healthcare organizations) often suffer from policies that do not allow for long-term commitments, and lack a culture and incentives for accountability and risk-taking.
Wellville helps stakeholders in five small communities to follow through on their (and our) commitment to the proposition that health depends primarily not on medical care, but on a richly interrelated set of social, emotional, nutritional, economic and educational supports. People need to feel both empowered and accountable. We are two years into a ten-year engagement that we believe will build sustainable institutions and cultures in each community, and models and inspiration for the rest of the world.
Our solution is the cultivation of health. It requires changing how the bulk of spending on health currently flows, too late, into disconnected medical silos. We want to help create a new market, where health is an asset and a vehicle for investment (by business, government and non-profits), yielding not only financial returns (as spending on medical care decreases in inverse relation to spending on programs that keep people from getting sick in the first place), but just as important, returns in community vitality.
We focus on two key activities:
- Helping community members to work together and to assume the risks and accountabilities of setting clear goals and implementing specific plans and milestones, and finding funding to achieve them, often in conjunction with replicable, evidence-based training, programs and technology.
- Providing real-time and ultimately retrospective evaluation of the impact of these programs in addressing both upstream factors (social determinants of health) and specific health and clinical outcomes.