“Americans of all ages, all conditions, and all dispositions constantly form associations,” wrote French observer Alexis de Tocqueville in the 1830s. “If it is proposed to inculcate some truth or to foster some feeling by the encouragement of a great example, they form a society.” Could this organizing spirit hold the potential to transform the nation’s health care?
With the House in Republican hands, it appears that the 2010 Patient Protection and Affordable Care Act will be at least in part modified. Undoing the most ill-considered pieces of the bill would be good, but the need for reform remains. Americans’ dissatisfaction with the existing system gave impetus to change in the first place; going back to the status quo ante is not advisable.
As is often the case, a crucial aspect of health policy reform is recognition that government policy, no matter how brilliant, cannot solve all of our problems. For example, one vital step on the path toward a healthier America is reigniting a sense of personal responsibility for health-affecting decisions. Policymakers can promote but not ensure progress toward this goal. The recent successes of some small town initiatives demonstrate how voluntary associations can play an important role.
Nevada City, Calif., resident Carole Carson created the Nevada County Meltdown  to encourage and assist people in her community who wished to lose weight. Working from her own experience of the necessity of support from family and friends, Carson and fellow organizer Mike Carville set up a contest where teams competed to shed pounds.
The whole community backed the effort. Health professionals offered services such as blood pressure checks. Restaurants implemented low-calorie menus. Groups organized walks and other fitness activities. Healthy living became a common goal, its benefits extending beyond physical wellbeing. “The most important thing about it,” observed one participant, “was that it was such a fabulous community thing.”
Other towns that imitated Nevada City’s program achieved similarly edifying results. In Fossil, Ore., some weight loss contestants’ health improved so dramatically that they were able to avoid pending orthopedic surgery and discontinue insulin shots for diabetes.
The medical costs of obesity amounted to $147 billion in 2008, according to one study . Chronic illnesses such as diabetes consume 75 percent of the more than $2 trillion that Americans spend on health care. Many of these diseases, writes Dr. Donald Condit in A Prescription for Health Care Reform , are “influenced by modifiable risk factors.” Lifestyle changes that prevent or reverse such conditions are critical to reining in health care spending, not to mention improving the quality of life for those who are affected. The trick is motivating people to change.
Some government programs might help, but the more effective approach is the one taken by these communities, because it is based on a realistic understanding of human nature. “We’re social animals,” Carson says. “We have a profound impact on each other—for good or ill.”
This impact is most profound when it does not occur through compulsion of one sort or another (as government programs usually do) but when it employs a subtler array of social influences. When family members, friends, co-workers, and community leaders promote a cause or, better yet, demonstrate in their own lives the benefits of living a certain way, we are encouraged and potentially persuaded to emulate their actions. When we are compelled to do something, our natural reaction is to seek ways to circumvent requirements. When we are persuaded, we view the decision, the effort—and the accomplishment—as our own.
The experience of one man in the town of Albert Lea, Minn., confirms the range of benefits possible when a community unifies around the mission of health. After he joined a neighborhood walking team, he pulled out of depression, lost weight, and went off his diabetes medication. “It wasn’t just the walking,” a town official says. “It was the caring.”
This kind of health care reform can’t be orchestrated by policy experts in Washington. Yet it would go a long way toward solving the systemic problems that have proved so nettlesome to lawmakers, whose search for solutions usually overlooks the potential inherent in every village and neighborhood in America.