How a Maine Program Reduced Heart Disease

Community programs to help residents reduce their risk factors for cardiovascular disease (CVD) have had sporadic success.

In rural Maine, however, such an effort has had sustained results lasting over a 40-year period, N. Burgess Record, MD and colleagues report in the Journal of the American Medical Association.

In an initiative begun in the late 1960s Franklin County ME, a new Community Action Agency and a new nonprofit group practice called Rural Health Associates worked with other community groups to recruit primary care physicians. Using federal grants to fund the startup of Franklin Area Health Plan, a new capitated insurance plan for 3,000 indigent residents, Record and colleagues then started Franklin Cardiovascular Health Program.

Other institutions and organizations joined in, including the University of Maine’s local campus which developed a health education degree program and trained local people to become CAA outreach workers.

The multi-pronged public health effort resulted in participants getting individual attention to help them become aware of their CVD risk factors and do something about them.

Those factors included hypertension, hyperlipidemia, and smoking status. Obesity and sedentary behavior were also addressed.

Some of the efforts involved sending vans of workers out to reach residents and do screenings and educate them; getting media participation to endorse their efforts; recruiting hundreds of volunteers including more than 200 nurses; and finding creative ways to reduce smoking. For instance, they used “motivated high school students” to participant in sting operations to prove that some establishments were selling tobacco to underage kids.

Schools were persuaded to start serving healthier meals, and a major community fund-raising effort led to the construction of a health and fitness center with the area’s only indoor pool.

Over the years, 150,000 residents had an average of 5 contacts with workers involved in the programs.

Among the results, hospitalization rates and mortality declined, including cardiovascular deaths. The rate of smokers who quit rose from 48% to 70% from 1994 to 2010. The rate of cholesterol control rose from 1% To 40% from 1986 to 2006. Treated and controlled hypertension rose from 18% in 1974 to 42% in 1977-78, just a few years after the program was started.

Could this program work elsewhere? The authors credit its success to community-wide support by both residents and caregivers.

They also noted that there could have been other factors that lead to the healthier status of residences including the possibility that demographics of the county could have changed over the study period.

“However despite these limitations, the most plausible explanation for the observed health benefits appear to be sustained community-wide programs to improve health.”

In an accompanying editorial, Darwin Labarthe, MD, MPH, PhD, and Jeremiah Stamler, MD agreed., agreed,. “The Franklin County, Maine, program demonstrates significant accomplishments in one northern US rural community that have made a difference in cardiovascular outcomes, “ they wrote, “The experience deserves consideration as a model for other communities to emulate, adapt, and implement.”