Last year my friend, Chelsea Clinton recommended I read a book by the former head of the National Health Service in Great Britain called Turning the World Upside Down – about what we can learn from poor countries in the developing world about putting patients and communities at the center of health care, not doctors and hospitals.
It inspired me to find ways to build community based solutions for the epidemic of chronic lifestyle driven disease – an epidemic that now kills twice as many around the world every year as infectious disease. Chronic disease is a slow motion disaster, a tsunami of suffering whose global cost will be $47 trillion over the next 20 years.
I realized we had to decentralize healthcare, and put patients and communities at the center of the solution empowering them to create health, not simply treat disease. I realized that if you were sick, the best place to create health might not be the doctor or clinic but your own community.
Our Global Obesity and Diabetes Epidemic
One in two Americans has pre-diabetes or diabetes—that is every other person in America. Twenty five percent of diabetics and ninety percent of pre-diabetics are not diagnosed. Caring for them will cost $3.4 trillion over the next 10 years. One in three Medicare dollars is spent on treating diabetes.
This is a global problem. From 1983 to 2011 world-wide diabetes prevalence increased from 35 million to 366 million and is projected to grow to 552 million in 2030. Ninety five percent of diabetes is lifestyle induced type 2 diabetes. The world’s best-selling blockbuster diabetes drug, Avandia, has killed nearly 200,000 people from heart attacks since it was introduced in 1999 – the very disease that kills most diabetics. The solution to our diabetes epidemic will not come from within the health care system. It will not come at the end of a pill bottle or the blade of a scalpel. We cannot bypass the fact that this is a lifestyle disease and cannot be solved by better or more medication.
Doctors graduate medical school knowing more about treating malaria than treating obesity — or what I call DIABESITY – that now accounts for most the patients they see. We need to rethink medicine and rethink health care. When the collective cost of diabesity related disease – heart disease, cancer, dementia, strokes, infertility, depression and more is accounted for, it is the single biggest contributor to our health care costs and our national debt. Seventy percent of our federal budget is spent on Medicaid, Medicare and Social Security. It is unsustainable.
In the face of those seemingly insurmountable statistics, I had an insight after working with Paul Farmer in Haiti where he built the model of accompaniment – community health workers and peer support that created the conditions that led to health.
The insight was this – that the community could be the cure.
I realized that getting healthy is a team sport!
An Unexpected Solution to Diabetes, Obesity and Chronic Disease
So one year ago, on January 15, 2011, in partnership with Rick Warren from Saddleback Church in Orange County and two other doctors (Dr. Daniel Amen and Dr. Mehmet Oz), we launched The Daniel Plan – a social experiment to learn if community support was more effective than medication or conventional medical care for treating and reversing disease and creating health.
The Daniel Plan is a wellness program delivered through small groups in the church. Rick Warren’s church of 30,000 met every week in 5,000 small groups. That was the secret sauce. The program is named after biblical story of Daniel and his small group of men who refused to consume royal food and wine. By eating vegetables and water, “they looked healthier and better nourished than any of the young men who ate the royal food,” according to Daniel 1:15.
In the first month 15,000 people signed up, and over the last year they have lost an estimated 250,000 pounds – or the equivalent of 10 tractor-trailer trucks loaded with soda. Over 6,000 people spontaneously joined from around the country. There have been over half a million visits to our Daniel Plan website from 189 countries. Hundreds of churches from around the country have called to participate and build programs for their own churches. Rick cast a vision to scale this through faith based communities to 1 billion people.
The results appear to be more effective than conventional medical care for chronic disease. The program is based on functional medicine – a way of treating chronic disease through lifestyle based systems solutions – not just treating symptoms. It is the science of creating health, not treating specific diseases. Disease goes away as a side effect of creating health. That delivered within small groups via The Daniel Plan was the lever than moved mountains – of donuts, ribs, soda and more!
Not only were there estimated weight reductions of 250,000 pounds but also equal reductions in medication use, hospitalizations and doctors visits. And it was free.
In a survey after 10 months of the program, participants reported the following:
- An average weight loss of 13.5 pounds (and 18 pounds for those who said they followed the program closely)
- 72% of those who wanted to lose weight did
- 53% reported increased energy levels
- 34% reported better sleep
- 27% improvement in blood work
- 20% reported improvement in blood pressure
- 11% reported reduction in medications
- 31% reported improvement in mood
Those who did the plan together lost twice as much weight as those who did it alone.
People like Chiquita Seals lost 125 pounds and Kendall Rock reversed his diabetes. Others got off their insulin, heart disease and diabetes medication. Hear them share their stories.
This past weekend at one of our rallies which highlighted healthy cooking demonstrations with pastors and doctors and chefs on stage, a man come up to me after the event and said that in the previous year he was in the hospital four times and on nine medications and this year he stayed out of the hospital and is only on one medication.
Here was the big insight for me: the community is the cure and the group is the medicine – not just a delivery system for health education.
We created an interactive curriculum delivered through multiple media – online education, videos, articles, recipes, webinars all done in small groups and community events. We did this at Saddleback by changing the culture – changed what was served at bible breakfasts, the menus in the refinery and even what people served in their homes and their small groups. People learned to create health together — to shop, cook, eat, exercise and play together.
We didn’t treat disease. We didn’t create a weight loss program. We taught people self-care and combining that with caring for each other they created a small miracle – something heath care or health care reform has not been able to achieve. In the most unlikely place, a large Church in Orange Country, led by Pastor Rick Warren and a Christian, Jewish and Muslim doctor we showed that community based solutions are more effective at treating and reversing chronic disease than our health care system. People helped each other create health.
As Chelsea Clinton suggested we need to turn the world upside down. We need a disruptive strategy from outside health care and conventional channels. This is the seed of a bigger possibility. In our own communities, in our homes and schools and workplaces and our faith based organizations we can support each other to take back our health.
Innovative community based models also can change our default choices for how we live, move, eat and play. If the things that create health are easy to access and things that create disease are hard to get to, extraordinary change occurs. In Albert Lea, Minnesota a pilot project was created to create healthy choices or invisibly limit bad ones. For example, by not allowing kids to eat in hallways and classrooms their weight went down 10%. In Thailand, a community garden is irrigated by an old bike hooked up to a generator run by patients with diabetes. They get exercise and grow healthy food!
This model has been replicated across the world – including Peers for Progress that created pilot programs to treat diabetes in Cameroon, Uganda, Thailand and South Africa based on peer support. The peer support group models were more effective than conventional care intervention for improving the health of diabetics and health care costs decreased 10 fold.
This experiment that continues today at Saddleback may catalyze decentralized, community-based, systems approaches to health for corporations, cities, states and nations throughout the world.
An old African proverb says that if you want to travel swiftly travel alone but if you want to travel far, travel together.
In my next blog I will explore further ways in which we can collectively take back our health in our communities, how we can get healthy together.
My new book The Blood Sugar Solution, which comes out at the end of February is a personal plan for individuals to get healthy, for us to get healthy together in our communities and for us to take back our health as a society. Obesity and diabetes is a social disease and we need a social cure.
My personal hope is that together we can create a national conversation about a real, practical solution for the prevention, treatment, and reversal of our diabesity epidemic.
To learn more and to get a free sneak preview of the book go to www.drhyman.com.
Now I’d like to hear from you …
What do you think about using community as a cure for chronic illness?
Have you joined with friends or family to take back your health? What has your experience been like?
What ideas do you have for us to take back our health in our homes, schools, workplaces, and places of worship?
Please leave your thoughts by adding a comment below.
To your good health,
Mark Hyman, MD