By Daniel Zoughbie, founder, chief executive officer & president, Microclinic International
You don’t need a recitation of statistics to know that chronic, preventable conditions – including obesity-related diseases such as diabetes, heart disease and stroke – are killing millions, creating poor quality of life for many others and causing exorbitant healthcare costs.
I know firsthand how chronic conditions can change your life. Years ago, my grandmother passed away from diabetes complications in Palestine. The public health system was incapable of helping her. And, quite simply, most traditional efforts to stop the spread or reverse the epidemic of chronic diseases haven’t worked, especially in areas where medical care is scarce.
While improvements are necessary in healthcare delivery, quality and access, I began to consider the existing social and behavioral assets in communities that could better support chronic disease management. I was struck by the idea that behaviors – like smoking, overeating and sedentary lifestyles – can spread through someone’s social interactions. I wondered if the reverse was also true: could social networks support and propagate positive behaviors – eating healthier, exercising, quitting smoking, etc.?
With that background, Microclinic International (MCI) was founded to broaden the traditional scope of the global public health infrastructure, which tends to focus on the biological aspects of diseases, rather than the sociological factors.
Our model brings together groups of two or more in a “microclinic.” A microclinic is not a building, but rather a real-life social group formed by the participant’s family, friends, colleagues and/or peers. Each group first meets in a central location where they receive education and engage in collective activities to promote healthy lifestyles. Then, they take what they have learned back to their homes, businesses and social networks.
Our work relies on refocusing or optimizing what is already in a community. Microclinic programs do not require major investments in technology, infrastructure, or human resources. To fund and sustain a successful microclinic program requires participant recruitment, education, health screenings, and group support.
When MCI joins with a community, we identify community partners and assess needs, including health status, economic factors, the social and physical environment, and existing community assets. Then, MCI trains local facilitators in the microclinic method and provides guidance as the program progresses. When participants gather for sessions, they learn from local practitioners, educators and experts who know and understand the community and its needs and customs.
Our simple model has already been successful on three continents. Domestically, in 2011 Humana recruited and provided funding for MCI to bring our approach to Bell County, located in Appalachia in southeastern Kentucky.
With sponsorship from Humana, MCI and the Bell County Health Department launched Team Up 4 Health. Over two years, more than 500 residents in Bell County joined together in roughly 170 microclinic groups, making small, simple changes to improve their overall health and better manage or prevent major chronic conditions.
Weekly health education classes focused on making the healthy choice easier by having participants learn about healthy eating, sample unfamiliar healthy foods, and make regular exercise a habit. Local facilitators took participants to the grocery store to teach how to read food labels and make healthy affordable food choices. Participants took cooking classes together, shared healthy recipes, and audited their team members’ refrigerators, looking for opportunities to swap out unhealthy foods.
The program was a resounding success: Participants lost an average of 6.52 pounds. At 16 months, participants had maintained an average decrease of 4.70 pounds, relative to the control group, which received only regular monitoring procedures for the purpose of data collection.
And, a peer-reviewed randomized controlled trial published by the American Heart Association’s Journal, Circulation, found our model demonstrates “promise for the power of social networks to propagate healthy lifestyle behaviors for public health.”
We weren’t surprised that people got healthy. However, we were surprised that the entire county seemed to join in to make the healthy choice the easy choice. Three local parks now have fitness equipment, and the county has a new five-acre community garden where residents grow organic produce. Also, local schools have designed and implemented programs of their own to promote nutrition and physical activity.
On a personal level, Willene Black has now made walking a regular habit since going through the program with her brother. She now reads food labels carefully, eats more fruits and vegetables and less fried food, and avoids high-calorie treats and soda. She’s shared her new habits with her granddaughter as well, who has gone on to reduce her intake of sugary beverages.
Another participant successfully fought high blood sugar levels and obesity by learning portion control and continuing a walking program. Her success didn’t stop with her but extended to her neighbor, who was actually not even technically a part of her “microclinic.” The participant encouraged her neighbor to be her walking partner, and her friend lost more than 50 pounds.
At MCI, we are not simply concerned with impact. We are also concerned about how to help more people. So, with funding from the Centers for Disease Control and Prevention (CDC), we trained 30 new microclinic program facilitators across eight counties of southeastern Kentucky, who will bring the program to hundreds of residents with or at-risk for chronic disease this year alone. And, we continue to work with partners across the health spectrum – from health insurance companies, to federal agencies like the CDC, local public health institutions, and motivated community members like those in southeastern Kentucky – to scale-up the program, making good health contagious in every city, state and country around the world.
The microclinic program has proven effective across the world and in many different institutional settings. For more information on MCI’s work, visit our website at www.microclinics.org or to find out how to bring the Microclinic Program to your community or institution, please contact us at firstname.lastname@example.org.