NewPublicHealth Q&A: The Y's Jonathan Lever
This morning, the U.S. Department of Health and Human Services along with several partners launched Million Hearts, an initiative that HHS hopes will prevent one million heart attacks and strokes over the next five years. One of the partners in the initiative is the YMCA, whose involvement will include an expansion of their national Diabetes Prevention Program. NewPublicHealth spoke with Jonathan Lever, Vice President for Health Strategy and Innovation at the YMCA of the USA about the Y’s ongoing focus on improving the health of communities.
NewPublicHealth: The Million Hearts program continues the YMCA’s community health efforts. The local YMCA has always been a place where motivated people could come to get healthy. How did the Y become involved in making whole communities healthier places to live?
Jonathan Lever: Our work in this space actually started with the Robert Wood Johnson Foundation about ten years ago. A few YMCAs on the West Coast got a grant to explore opportunities for a group of people that we now call health seekers – people who struggled to adopt and sustain healthy lifestyles. They needed continuous support and encouragement in adopting healthy lifestyles, and this was a relatively new sort of segment of the population for the YMCAs. It was through that research grant that we really began to think about what is the YMCA’s role in helping individuals, families and communities.
NPH: What are the key initiatives that the Y has focused on to improve the health of communities?
Jonathan Lever: Our initiatives are really broken down into two different buckets of activities. There are programs that are focused on individuals and families and programs focused around communities. One of the unique things about the Y is that we can operate in both spaces.
With respect to individuals, we are increasingly focused on programs for people who are at risk of developing chronic diseases. The Y’s Diabetes Prevention Program would be an example of that. We are also offering programs that help people who already have a chronic condition live well or live better or reclaim their health through those programs and we have a partnership with the Livestrong Foundation for cancer survivors, for example.
For communities, we have our Healthier Community Initiatives, which include a whole range of different efforts focused on policy, systems and environmental changes. This allows the Y to be a catalyst for change at the local, state and ultimately at the national level around policies and systems changes to make the healthier choice be the easier choice. We now have 200 communities operating these initiatives.
NPH: How do you think partner involvement has helped to move the projects forward?
Jonathan Lever: That’s a great question. I like to think that the Y is the Switzerland of the community. The Y can bring a lot of disparate groups together in a safe and amicable way. For example, we often bring Chambers of Commerce into the conversation because obviously employers and the business community have a large say in how health is perceived and executed in communities. We also need to bring the public health community together. You need the public health infrastructure to be serious in these policy systems environmental change efforts. We need to work with universities and academic partners because many times the Y can help drive an agenda and get things done, but we need the expertise of others to evaluate the impact of that work.
NPH: What are some of the successes the Y has had in making communities healthier through policy and environmental changes?
Jonathan Lever: We’ve spent quite a bit of time trying to get a handle on that very question. We recently did a survey of our sites that were involved in our Healthier Communities work, and we got a sample of about 90 of them, and we determined that those community coalitions influence almost 15,000 policy, systems and environmental changes to support healthy living in their communities and that’s impacted about 34 million lives. Because of that, there are 73 new or improved grocery options in communities, there are 278 new community gardens, there are 75 new farmers markets, 65 new mobile markets or fruit stands, There are 45 action plans to address food deserts and 112 sidewalks designed or improved to increase physical activity options. These additions or improvements are linked to communities in which the Y has been the catalyst for the community coalitions around this work.
NPH: Are the programs that the Y is promoting evidence-based?
Jonathan Lever: Yes. We are increasingly more vigilant about rallying around evidence-based programs and the Diabetes Prevention Program is a perfect example of that.
The research came out of a National Institutes of Health study that involved 27 different university centers. It was about a $200 million research effort, one of the biggest NIH studies around, and it looked at whether lifestyle intervention was more effective than a drug or a control group and the study showed that actually the lifestyle intervention was by far the most impactful, and it was so impactful that they actually ended the research intervention early because they didn’t think it was ethical to continue the trial. The study was published in the New England Journal of Medicine in 2002 and was heralded by prevention experts as proof that prevention works. And then no one did anything with it. The research sat on a shelf for about 6 or 7 years until the Y partnered with Indiana University and asked, “how do we actually make this real for real people?” We took that program and we adapted it to the Y setting. We converted it into a group-based program and said let’s hold ourselves to the same standards and see if we can get the same results, and lo and behold, we got the same results and have now spread that program to 43 Ys in 23 different states from the one Y just a couple of years ago.
NPH: What other disease areas are there or might there be other than diabetes that you’re focusing on?
Jonathan Lever: We’re looking at a whole range of conditions, including risk factors for cardiovascular disease, with today’s announcement [about the Million Hearts campaign]. We are also looking at arthritis and fall prevention programs. If you think about chronic disease in terms of primary, secondary and tertiary prevention where primary prevention is really for anybody, secondary prevention is for people who are at risk and tertiary prevention is for people who have a condition already, the Y has historically been in the primary prevention space, but now it’s spanning into both secondary and tertiary prevention.
NPH: How are you helping participants pay for the cost of the programs?
Jonathan Lever: We have many insurers that are enrolling their folks into our program and subsidizing their employees’ participation in the program. And we see that as important because people are much more apt to participate in these programs if their employer or their insurer subsidizes the cost or even covers it entirely. And we look to scholarship people into our programs if they can’t afford to pay. We’re even doing some programs now with federally qualified health centers where we go on site to deliver programs at the health center or at the clinic. It’s a very real issue for us. We feel like we are on the cusp, that the whole country is moving in this direction where we have to find ways to reduce costs, and one of the things that’s so wonderful about the Y is the people that deliver our programs aren’t nearly as expensive as a doctor or a nurse or most other health care professionals. So in many ways we’re able to deliver evidence-based programs in a quality way at significantly lower cost.
NPH: How does a health department engage a Y to help improve health in a community?
Jonathan Lever: We need the public health community as much as the public health community needs us. The public health community can help deliver the message that whether it’s the Y or other community-based organizations, that there are many advantages for the delivery of health care in these non-clinical settings. Especially if we can hold ourselves accountable, measure our outcomes, then the doctor or the health department can feel confident that when they send the person to the Y, they know they’re going to get great care, they’re going to get great outcomes and they’re ultimately going to help people live healthier lives.
It’s critical that public health understand that the Y is open for business, if you will, in this space. We are eager to work with the public health department and it can be a mutually beneficial partnership because at the end of the day, the public health department really can’t deliver interventions themselves. They can help educate, they can help spread the word, but they’re not really configured, they’re not on every street corner. And so they need places like the Y and the Y needs their credibility to make the case that we’re in a good place to help service the public needs.
NPH: What’s the next chapter for the Y in improving the nation’s health?
Jonathan Lever: We have been in the community for nearly 160 years, but we want to be much more focused on addressing chronic disease in this country, whether it’s the primary, secondary or tertiary prevention space. Nearly 60% of households are within 3 miles of a YMCA, so we feel a huge obligation to put this incredible asset into the public domain in a way that we can really help address America’s health crisis. We don’t think the Y can singlehandedly change health in America, but we don’t think health in America can be changed without the Y. We’re nearly ubiquitous, we have infrastructure already in place and so we have a responsibility and an obligation to live up to that potential.