In recent years, gerontology researchers have trekked into a remote mountainous region of Sardinia to interview one of the largest groups of long-lived people in any single area of the globe.
How did they stay healthy for such a long time, and what can other populations do to emulate them? Is it gene selection controlled by isolation? In one area, outside contacts have been almost non-existent since the 11th century. Or is it diet and hard work?
As one 103-year-old told writer Jason Wilson, “Everybody wants to know the secret, but there is none.”
That doesn’t quell the search for answers.
PracticeLink selected four “healthy” cities to learn about reasons for their citizens’ robustness, including the role played by medical professionals. Not all of their approaches are quite the same.
Each city and its hospital(s) have developed programs and activities to promote healthy living. But equally important, each in its own way has become a mecca for physicians seeking new locales and challenges.
Good health—or else!
When 92 percent of a city’s residents say they’re in good or great health, there has to be a reason—or many reasons. In Burlington, Vt., the explanation combination may start with the fact that Vermonters are legendary for their sturdiness. Abundant opportunities for outdoor activity also play a large role. But the trump card in recent years has been an all-out campaign by the medical community to promote wellness practices.
To set the stage, “It’s a very health-conscious town, and a very active town,” says Steven Grant, M.D., an internal medicine hospitalist with Fletcher Allen Health Care (FAHC) for 12 years.
“For the kind of people who want to come here, it’s a little bit of self-selection. They like a smaller place, a place where having the outside is part of their priorities and where it’s not just fast food around the corner.”
In an arrangement unusual for a small city, FAHC is one arm of a medical “empire” including 30 patient care sites in nearby towns and rural sections of Vermont as well as towns across Lake Champlain in northeastern New York State. FAHC is also the teaching hospital for the University of Vermont’s College of Medicine. Both are on the same campus.
“If you were a ‘triple-threat doctor,’” Grant points out, “meaning clinician, teacher and researcher, you could be doing your research, go to the hospital and meet medical students, all right there, all walkable, all in one place.”
Clinical convenience aside, he talks enthusiastically about the great outdoors and the ease of getting drawn into the skiing, boating and hiking crowd. “Burlington is in a beautiful location—a city on a big lake and surrounded by mountains on either side. You have the Green Mountains here in Vermont, with beautiful rolling hills, and on the New York side, the Adirondacks, which are bigger and much more rugged.” Plenty of outdoor opportunities—and they all meet his good-place-to-live specifications.
Although he went south for medical school and residency at Emory University in Georgia and Charlottesville, Va., growing up in the Detroit area and attending the University of Michigan cemented Grant’s outdoor preferences. “I grew up in snowy winters, and I was a skier. Snow sports were one of the things that definitely attracted me to the Burlington area.” His more recent favorite, though, is snowboarding. “I switched when my daughter (now 14) was just learning to ski. I said, ‘I need to learn something, too, so then we’ll both be learning.’”
But his outdoor pursuits don’t end there. Add snowshoeing, mountain biking, biking to work, hiking and running, plus “doing weights a few days a week.” He concludes, “I like to keep some variety going. And if you ask most of the doctors I work with, they all do the same. It’s just part of the culture.”
The long-term, overriding reason for the region’s good health probably lies in the many and aggressive efforts by FAHC to establish programs encouraging healthy practices by residents. Penrose Jackson, director of Community Health Improvement for the hospital, ticks off some of the initiatives covered by her team, which has grown from about two members in the 1980s to more than 60 now: Poison prevention, child passenger safety, pre-diabetes and diabetes checkups, early hearing screenings for babies and children, tobacco cessation programs. Most ambitious, though, are three more wide-ranging efforts.
Aggressive Community Health Teams teach people to take better charge of their own health and be better proactive patients. “The results have been pretty remarkable around reduction of admissions and readmissions to the hospital,” she reports.
A community needs assessment partnership with other organizations is a brief intervention program available to some 150,000 persons in the hospital’s care area.
FAHC is also a major player in the Vermont Blueprint for Health. It features health teams, including physicians, that establish medical homes so patients can have their care monitored, learn about services they may not have known about and be reminded of routine tests.
Grant’s own career “journey” began with a suggestion from his wife, a UVM graduate, that he might like the town. “I took one look around during a beautiful sunny day,” he reminisces, “with all of the Christmas lights on downtown in our cobblestone-street mall, and I said, ‘Yeah, I think this town will do for me.’”
The influence of students and faculty from the city’s colleges has generated a lively town atmosphere that includes unusual restaurants, concerts by nationally known groups and a large jazz festival every summer. Grant points out that there’s plenty of big-city activity just an hour and a half away in Montreal. As he summarizes, “It really is a paradise of different opportunities that you can have here.”
Though colleges and the hospital are the mainstays of the local economy, the Burlington region supports almost one-third of Vermont’s manufacturing employment, which includes everything from electronics industries and health care software to the Vermont Teddy Bear Company, now a worldwide provider of the cuddly pets. The area is also headquarters for one of the largest commercial oven companies in the U.S., a snowboard manufacturer and Bruegger’s Bagels.
As for the city’s “hale and hearty” status, the secret is out. Gallup-Healthways surveys cite it as one of America’s Top 10 well-being smaller cities. Among other kudos, Men’s Health Magazine has christened it number one.
The lure of the ocean
After working several years in Palm Springs, Calif., including a few as assistant medical director of the Desert Regional Medical Center there, Jeffery Davies, D.O., answered to the call of the sea—and an excellent job opportunity.
A year ago, he relocated to the Oxnard area, where he accepted the position of chairman and medical director of the ER at St. John’s Pleasant Valley Hospital in Camarillo, the sister institution of St. John’s Regional Medical Center in nearby Oxnard.
“My wife is from this area,” Davies explains, “so that’s probably the biggest pull. I wanted to be closer to her family, closer to Los Angeles (about 60 miles away)—and to the ocean. I thought, ‘This is the place I could live for the rest of my life.’” Lifestyle possibilities and his professional goals seemed to be in sync.
With a recent change in hospital leadership, the goal, he says, was to rehaul the entire medical system and upgrade the quality of care. “I liked the chance for problem solving and to grow the ER,” he says.
Davies cites upgraded cardio procedures as one good example of the new regimen. Medical involvement doesn’t stop when atrial fibrillation patients go home, he says. “Now we’re trying to improve communication with their primary physicians every time they come into an ER situation. For every single patient, an automatic copy of the procedure is sent to his or her physician, including every single medicine we’ve prescribed. We also have an educational discharge program,” he says.
Promoting good health is an ongoing activity throughout the St. John’s domain, such as through anti-diabetes and obesity education programs among youths and a Healthy Beginnings program for mothers-to-be.
A perfect growing climate enticed farmers to the area, and at the nearby Oxnard Harbor District, the Port of Hueneme attracted the attention of the U.S. Navy in World War II and major shippers after that. Today, cargo worth some $7 billion passes through every year, and 4,500 jobs in the county are related to these shipping activities.
Green technology and recycling are also part of the area’s fabric. Two examples are the greenhouses of Houweling’s, where probably billions of tomatoes are grown hydroponically under glass, and Gills Onions, one of the U.S.’ largest family-owned onion growers. Then there’s Agromin, a huge “organic management” company that produces “rich, living compost,” mulch and other top-notch products for farmers in the area.
“In Michigan, the place shuts down in the winter, and there’s pretty much nothing you can do,” Davies says. “Here you can get out every day and walk and hike and play golf and do all the other great outdoor things.” Not to mention excursions up the coast. As he says, “It’s a great, great opportunity and a great location. I was handed a golden gem. It’s called the Gold Coast for a reason.”
Along “Tobacco Road”
In spite of being one of the country’s largest tobacco-raising regions, the North Carolina “Research Triangle” of Raleigh, Durham and Chapel Hill is viewed as one of the healthiest areas in the state, according to Alan Wolf, the media relations coordinator at Rex Healthcare, one of three large hospitals in Raleigh. Each city is home to a major university well-known for its strong scientific investigations.
The Gallup-Healthways sleuths have dubbed this City of Oaks (nicknamed for its many trees of the same name) one of the healthiest large cities.
A good place to pinpoint some reasons might be the Senior Health Center operated by Rex Healthcare in southeast Raleigh. Its director since 1985, Leroy Darkes, M.D., has been an energetic crusader for wellness among a large African American community. An Atlantic City native with undergrad and medical degrees from Rutgers University, Darkes made his way South after several frustrating years with HMOs in Camden, N.J.
At that point, he reminisces, “I got a call to come down to Raleigh, and I came out of curiosity.” His reaction to a Rex offer: “I was actually thrilled.”
The assignment was to develop an inviting medical “home” that would provide treatment and tests, plus instruction on healthy living. “My mission,” he says, “was to build some bridges in the community that really had felt disenfranchised—and to be consistent and persistent.” At a gathering to discuss goals for the new center, one participant was the general manager of a local radio station. “I’ll get you on the air once a week,” he promised Darkes. Here was a golden opportunity to connect with potential patients and explain benefits of the facility.
“Long story short,” says Darkes, “I’ve done more than a thousand hours of community broadcasting. It has become a significant staple as far as dissemination of essential information. Once folks started calling in, it became rather addictive.”
Before long, he was explaining his mission from the pulpits of churches, enlisting civic organizations to help promote men’s awareness of, among other things, free prostate screenings. Screening sessions were set up at churches. “I chose prostate as our vehicle,” he reports, “but the principle could be (and was) applied across the board.”
Besides Rex Healthcare, Raleigh is home to two other hospitals, each promoting better health practices.
WakeMed Health & Hospitals has been aggressive in developing new treatment methods and speedier access to necessary care. It opened North Carolina’s first freestanding children’s emergency department, and has a dedicated ICU, both staffed 24/7 by pediatric intensivists. Among adult services, it became an early participant in mothers’ milk banks, has one of the highest-volume heart centers in the U.S.—and the sole neuro-ICU in the county.
Duke Raleigh Hospital, a sister facility to the large Durham institution, offers a variety of better-health activities, events and lectures, holds an annual community education event focusing on heart disease, a free-care clinic for uninsured adults and special diabetes programs for women and the Hispanic community. It also sponsors a weekly farmers market from April to November.
Rex Healthcare, opened in 1894, derives its name from an 1800s tanner, John Rex, who bequeathed building funds. Today’s mix includes a satellite in nearby Cary. Besides Darkes’ senior center, Rex’s activities include a few other good health stories. For instance, thanks to a chef’s initiative, all fryers were removed from the kitchen in April, the first such action in the state.
All of the above are enhancements to the beauty and charm of North Carolina’s tree-filled capital. Gracious Victorian and early 20th-century homes dominate a 30-block area, Historic Oakwood, where spring and Christmas tours are reminders of the gracious days of yore.
Children might yawn among Victorian houses, but not in Pullen Park, a downtown green area with kiddie-style train and 1911 carousel. There’s a lake with pedal boats and other rides. The park borders the Pullen Aquatic Center and a hiking trail, additional enticements for healthy activities. The Greenway network system is also a popular walking and biking area.
For the culturally inclined, Raleigh provides theater, ballet, symphony and opera—but the Triangle has a clamp like no other area on the college basketball scene. From North Carolina State University in Raleigh itself to Duke University in Durham, the University of North Carolina in Chapel Hill and Wake Forest University in Winston-Salem, the “Big Four” routinely reach NCAA tournaments. Fans respond accordingly. And—big surprise—the territory linking this quartet has an appropriate nickname: Tobacco Road.
Cedar Rapids, Iowa
The Iowa Way
“Iowa has the richest land, the lowest illiteracy rate . . . and the most moral and forward-looking cities of all the States.” That’s a quote from Sinclair Lewis’ Arrowsmith, the Pultizer Prize-winning novel about a young Midwestern doctor trying to make his way through a career life more complicated than he had expected. Its copyright is from 1924.
The world today is 1,000 percent different from the era Lewis wrote about. But to a certain degree, the description of Iowa still seems apropos.
Stanley Mathew, M.D., can attest to it. Mathew, whose parents immigrated to New York City from India, has had a much more cosmopolitan upbringing than the young Martin Arrowsmith. His medical degree is from the Medical University of Lublin, Poland, followed by residency at New York Medical College. Along the way to his current position at St. Luke’s Hospital in Cedar Rapids, Iowa, he co-founded a firm that, as he describes it, conducts clinical trials and services pharmaceutical clients in drug discovery and development.
Seeking work in 2009 after his residency, he learned of an opening with St. Luke’s. From the beginning, it was a fit. “I came out for an interview that went phenomenally,” he reports. “New York City is a great place. I never thought I’d leave, but when I finally moved to Cedar Rapids, I couldn’t believe how nice, accommodating and warm the people were. The New Yorker in me thought it was all a façade, but the longer you live here, the more you realize it’s the real deal.”
Among other discoveries: “There are more bike trails and joggers than I have ever seen. There are a lot of very nice parks in the area that have great walking trails.” This lifestyle coordinates well with his specialty, physical medicine and rehabilitation. “We talk a lot about exercises,” he says. Mathew follows his own advice, taking advantage of “more opportunities to be outdoors, going for hikes and heading to the gym a few times a week.”
The city itself, second largest in the state, offers a multitude of opportunities for outdoor exercise and fun, including 74 parks, miles of trails, golf courses and aquatic centers. Opportunities multiply at the nearby Pleasant Creek State Recreation Area for hiking, biking, snowmobiling, cross country skiing and horseback riding.
It all verifies the area’s high ratings in the annals of healthy cities. So does RAGBRAI, an acronym for the Register’s Annual Great Bike Ride Across Iowa.
In the meantime, numerous good-health incentives are incorporated into the general routines at both Cedar Rapids hospitals, St. Luke’s and Mercy Medical Center. Among other efforts, Mercy schedules adult vaccinations in its lobby, has held a Save Your Lungs event at a local mall and was the first hospital kitchen in the region to replace its deep fat fryers with convection/steamer ovens.
St. Luke’s “healthy roster” includes programs on childhood obesity, blood pressure checks and fund-raising walks. “There’s also a nice track on the hospital’s third floor,” reports Sarah Corizzo, the media relations specialist. “It’s mostly for heart rehab patients, but city people can use it, too.”
If Mathew needed any additional proof of hardworking, indomitable Iowans, his best example could be the city’s recovery efforts after its worst-ever flood of 2008, when water rose 31.12 feet and inundated more than 7,100 properties in a 10-square-mile area, at least 14 percent of the whole city. Four days later, 2,680 local residents attended three public open houses to discuss plans for recovery, reinvestment and revitalization. Four years later, several new and rehab projects are complete, and the work continues.
Says Mathew: “Over the last two years, the city has become more vibrant, with more restaurants and stores opening up in downtown, and the rest of the city is still growing and doing well.”
Business and industry are also doing well. Cedar Rapids is noted as the largest corn-processing city in the world, not a surprise to anyone who has passed farm fields in late summer. It’s also the second-largest producer of wind energy in the U.S., and one of North America’s leading bio-processing and food ingredient centers. But the best news may be that employment is expected to grow 14.2 percent within three years, the strongest forecast of any American metro area.
Also alive and very well is its cultural and recreational life. The city is part of the Iowa Cultural Corridor Alliance, which includes 150 organizations in 11 eastern counties. Orchestra Iowa has been a staple since its founding in 1921. There are performances at the opera theater and plays in at least four theaters. A children’s museum keeps company with others devoted to history, African American culture, art and collectible cars, as well as a museum and library devoted to the state’s large Czech and Slovak heritage.
And, just for fun, there’s the whimsical Cedar Rapids slogan: “City of Five Seasons.” It all started in 1968 when an advertising agency touted the city’s short commute time as evidence that there’s more time for enjoying life—a fifth season.