FARMINGTON, Maine - An article published today in the Journal of the American Medical Association highlights the unique efforts to combat cardiovascular disease in Franklin County, Maine.
Beginning in the 1970's, several initiatives sought to reduce what is still the number one cause of death in the U.S. And the authors of the report say the data show those efforts have successfully improved the odds in this rural county.
Franklin County isn't the type of place you expect to see this type of success. It's a low-income, aging population.
"Most epidemiologists would agree, poor people and poor populations have poor health," says Dr. Burgess Record. Dr. Record is a physician who helped implement Franklin County's Cardiovascular Health Program. He's also the lead author of the JAMA report.
Record says back in the late 1970's, several health advocates wondered if they could reverse expected outcomes for patients in Franklin County. They set a goal to prevent cardiovascular disease, and enlisted the help of hundreds of volunteer nurses.
Sandy Record, who is married to Burgess Record, worked for 32 years as nurse manager of the Franklin Cardiovascular Health Program.
"Where they lived, where they worked, where they played," she says. "To schools, to work sites, to communities. And had one-on-one with each individual over a long period of time, and so there became that trusting relationship."
Nurses took blood pressure and referred patients to physicians. They helped community members improve their diets, quit smoking, and exercise. Record remembers one physician who shared walking maps created by the program with patients.
"He had a book, and when he'd see patients, 'So - where do you live? Oh - there? You're not walking? Here - here's your safe map. Go back and tell me how many times you've walked this route," she recalls. "It was incredible. That simple little project made a big-time difference for these people."
Franklin County's multiple, overlapping interventions,- along with the integration of public health with primary care - is what made the program unique, and successful, according to the JAMA study.
Over the years, smoking cessation rates have improved from about 50 percent to 70 percent. Cholesterol control has increased almost 30 percent. Hospitalization rates, which are strongly associated with household income, have been significantly lower than expected for Franklin County.
"What might be the lessons from what we've done here for others? We think there are several, potentially," says Dan Onion, a doctor who participated in the program. He says a community approach to health care is key - and that means the entire community - to help create cultural changes.
"In addition, recruiting multiple categories of community partners from schools to universities to police, service clubs, hospitals, and low-income advocate organizations," Dr. Onion says, "and jointly plan and implement programs together."
Onion says a lot of this work depends on grant funding and volunteers. But he says the Affordable Care Act does offer some structured support.
The big take away, he says, is that low-income, rural populations don't have to be doomed to poor health, and that the Franklin County model can be replicated anywhere to combat chronic diseases.
