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Vital Signs

Keene has a vision of health, not just health care

A Keene statement about community.

By Rebecca E. Glover

Every Halloween, Keene, N.H., hosts one of the largest pumpkin festivals in the world. Dr. John Schlegelmilch, chief medical officer of the Dartmouth-Hitchcock-affiliated Cheshire Medical Center, believes the community spirit that goes into carving 25,000 orange orbs can be harnessed to promote healthy living. About half of a person's health is dependent on personal behaviors, says Arthur Nichols, Cheshire's CEO. That's why an initiative called Vision 2020 focuses heavily on lifestyle changes and disease prevention.

Model: There's wide agreement that prevention needs to be built into the health-care system but disagreement about how to do so. Currently only 5% of health spending goes to prevention, according to a national report, while the rest goes to diagnosis and care. Perhaps this relatively isolated, self-contained, pumpkin-loving corner of New England can provide a model for the rest of the country.

In 2006, Cheshire helped launch Vision 2020, an effort to make the greater Keene area the healthiest place in the U.S. by 2020. This year, Cheshire partnered with the local public schools and C&S Wholesale Grocers to create a program called 5-2-1-0, in which parents and children pledge to eat five fruits and vegetables a day, limit TV and computer screen time to two hours, do one hour or more of physical activity, and drink zero sugary drinks. "Our main role here is to mobilize," says Nichols.

Hub: "We feel responsible for the entire community," Schlegelmilch adds. A medical hub for the area, Cheshire serves Brattleboro, Vt., and numerous small towns in New Hampshire and Vermont, as well as Keene.

"What we're trying to do here is change culture," says Schlegelmilch.

Vision 2020 was built on a strong foundation. New Hampshire and Vermont consistently rank among the healthiest states. New Hampshire's exceptionally low rates of child poverty, violent crime, and premature death, along with high immunization rates, mean Keene is better off than many places in the U.S.

Cheshire's relationship with the community has been strong for many years, too. For example, hospital officials work with area schools to help children from low- and moderate-income households obtain health insurance; run a medication assistance program for needy individuals; help low-income children and adults access dental care; and offer numerous services for senior citizens. Many additional free programs are also readily available, from childbirth classes to support groups for cancer patients. In 2008, Cheshire spent $1.4 million on community health programs.

Cheshire is putting a lot of emphasis on tobacco cessation and school-based smoking-prevention efforts. Here, too, there are deep roots. Keene was the first city in New Hampshire to mandate smoke-free restaurants, well before a statewide law went into effect. And recommendations from Cheshire were influential in Keene State College's decision to ban the sale of tobacco in campus stores, according to Schlegelmilch.

Measure: While it's clear there is no lack of action, it's not evident what impact the efforts are having so far. Fifteen indicators have been identified to measure Vision 2020's progress. They have to do with whether people have access to information and services, and whether they are able to achieve and maintain healthy lifestyles. The indicators were selected in year two, says Nichols, "so we are just reaching the point where we can . . . measure change over time." But Schlegelmilch and Nichols are optimistic that the infrastructure they're putting in place will have a long-term effect.

"What we're trying to do here is change culture," says Schlegelmilch. "Vision 2020 is not a program," adds Nichols. "It's a way of life."

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