You may have heard the story about how you can boil a frog to death without its realizing it. 

In case you haven’t, here’s how it goes: If you throw a frog into a pot of boiling water, it’s naturally going to jump out. But place that frog in a pan of cool water and slowly increase the heat to boiling, and it won’t notice until it’s too late. 

Similarly, Iowa and the rest of the United States are in the midst of a silent health epidemic, driven by gradual changes in our lifestyles and environment that have insidiously made one-third of Iowans obese and cranked up increases in life-threatening chronic diseases to record levels. 

Although Iowa has made progress toward its goal of becoming the healthiest state in the nation, much work remains to turn down the heat of chronic disease, say health experts and community leaders who are part of the Healthiest State Initiative. 

The initiative, which for the past five years worked closely with leaders in 15 selected Iowa communities to pioneer programs for improving the health and wellness of residents, is now using that experience to provide a broader set of tools for communities statewide. 

With a renewed goal to “create a groundswell of better health in Iowa communities,” Healthiest State Iowa officials on Nov. 1 announced a new program — Healthy Hometown — that will provide communities of all sizes with an online tool to customize local health and wellness initiatives. 

In conjunction with the fifth anniversary of the launch of Healthiest State Iowa, the Business Record is taking a look back at what health leaders and communities have learned and accomplished so far, and what’s on tap as it moves forward into 2017 and beyond. 

Driving down the rate of chronic disease is a key factor in addressing high health care costs and improving well-being for Iowans, experts say. Although progress has been made through initiatives begun by Healthiest State Iowa statewide, reversing current health trends will continue to be one of the biggest and most significant efforts the state could make.  

If trends remain the same, in less than 15 years the number of Iowans with diabetes is expected to increase from the present 262,775 to nearly 368,000, according to Iowa Department of Health projections — a 40 percent increase. 

Nationwide, between 40 and 50 percent of Americans born after 2000 are now expected to develop diabetes within their lifetime. 

Type 2 diabetes, like several other chronic diseases that Americans are acquiring at an accelerating pace, is a lifestyle-driven disease, said Dr. Todd Whitthorne, president of ACAP Health Consulting, a wellness consulting subsidiary of Holmes Murphy & Associates based in Dallas. 

“If there’s one thing that’s going to bankrupt our country, it’s diabetes,” said Whitthorne, who was recently the featured speaker at a five-year anniversary event for Healthiest State Iowa. He provided sobering statistics about one of the biggest health challenges facing Iowa and the nation. While 12.3 percent of Americans now have diabetes, another staggering 37 percent of all Americans are estimated to be pre-diabetic. 

“They’re on the diabetes escalator, and if they don’t make changes to get off that escalator, they will get diabetes,” he said. “And 90 percent don’t even know they’re on that escalator.” 

How does this relate to Healthiest State Iowa? Whitthorne said that if someone who is obese loses just 3 to 5 percent of their body weight, that can have a measurable impact on their risk factors. “If we can help folks develop new habits, we can change their health.” 

Currently, more than half of health care dollars spent in the state are for treatment of obesity-related chronic diseases, said Laura Jackson, executive vice president of Wellmark Blue Cross Blue Shield and chair of Healthiest State Iowa’s board of directors. 

“We need to turn the tide and reverse this epidemic,” Jackson said. 

Report shows some progress
Although Iowa’s relative ranking compared with other states — as measured by an annual Gallup-Healthways nationwide survey that Healthiest State Iowa has used as its official bellwether — has moved both up and down in the past five years, it has improved significantly when compared with the national average. Iowa’s raw score has actually improved twice as fast as the national average over the past five years, Gov. Terry Branstad said during a recent recognition event for Healthiest State Iowa. 

“This needs to be a launching pad for where we want to be in the future,” Branstad told representatives of the Blue Zones communities, which are now the founding Healthy Hometown communities. “This effort is important not only to our health but also to the future economic health of our state. If we are the healthiest state, it’s going to be a selling point to encourage more businesses to come here and create more quality jobs and careers.” 

Another measure of where Iowa stands is a Healthy Iowans report released in September by the Iowa Department of Public Health; the statewide effort tracks 61 metrics of health. That interim report found that 66 percent of the metrics either had been achieved or were moving toward the goal, while 34 percent were moving away from the goal or had stayed the same. 

Among the goals not achieved was a reduction in rates of adult obesity in Iowa. In fact, the rate has inched up from a baseline of 29 percent in 2011 to 32 percent in 2015. 

Some progress has been made in measures related to that goal, however. For instance, there has been movement toward increasing the proportion of adults who get the recommended weekly levels of aerobic activity. Other subgoals related to the obesity goal were: 

• An increase in the percentage of people who eat five or more servings of fruits and vegetables each day: No change from the baseline.
• An increase in the proportion of adults who get the recommended levels of aerobic physical activity: Moved toward the target.
• A decrease in the proportion of participants in the WIC program who have low or very low food security: Moved away from the target.
• An increase in the proportion of Iowa infants who are breastfed at birth: Reached the target.

Overall, the Healthy Iowans report represents “the burning platform” for change, said Becky Wampler, community health improvement officer with Wellmark, which is leading the health improvement programs for Healthiest State Iowa. 

“It’s really understanding … why it’s so important for us to do something and change what’s happening today, or we’ll continue down a path where we’ll continue to have more chronic diseases and spend more and more dollars,” she said. 

“We know within Wellmark that from what we pay out for health care services, more than 58 percent is spent on people who have up to three chronic diseases. And we know that obesity is the driver of chronic disease, so it’s really working backwards (to reverse that).”  

With conveniences like automatic garage door openers and television remote controls, combined with factors such as drive-thru fast food and long workdays — America’s built environment has evolved to the point where little physical activity is required. Consequently, it’s very easy to make unhealthy choices. 

“What we want to do through Healthy Hometown is provide communities the avenue for changing that built environment so the healthy choice is easier,” Wampler said. 

Evidence-based projects 
Using best practices developed from the Blue Zones program it conducted with 15 communities across the state, along with Healthiest Ames (see sidebar), Healthiest State Iowa created a menu of more than 200 evidence-based projects that can be carried out through the Healthy Hometown program. 

Three self-assessments are available: one for workplaces, one for schools and one for communities. For instance, a school principal might log on to take the school assessment and would receive a report with suggestions and tools for deploying initiatives such as a “walking school bus” program to get more students to walk to school. 

In January, Healthiest State Iowa will introduce options two and three of Healthy Hometown, which in addition to the assessment will provide two routes for communities to choose from — either a targeted health improvement project or a communitywide wellness makeover. 

Jami Haberl, executive director of Healthiest State Iowa, said Healthy Hometown is designed foremost for flexibility, so that after communities assess their current status they can best determine how they want to move forward. 

“For some communities, a priority project may make more sense,” she said. “For others, they may be ready to a complete makeover.” 

She estimated that Healthiest State has the resources to work with between 60 and 140 communities in the next several years, depending on how many choose to target specific projects versus those that want to launch a comprehensive communitywide effort. 

A new structure 
Going forward, one of the biggest changes in Healthiest State Iowa is its organizational structure, which has been tweaked to enable additional leaders and organizations to have a voice in its initiatives, Haberl said. 

A newly named leadership cabinet — which augments the nonprofit’s existing board chaired by Laura Jackson — includes some well-known state leaders. Among them are Mike Ralston, president of the Iowa Association of Business and Industry, and Cedar Rapids City Manager Jeff Pomeranz, who will co-chair Strategic Statewide Alliances. It’s one of five committees set up under the new leadership structure. 

“This infrastructure that we’re putting into place really has the opportunity to engage more Iowans,” Haberl said. ”Everything from marketing to community health improvement and even looking at performance — how do we measure both the short-term and long-term successes that we’re having?

Statewide alliances will be an important part of advancing Healthiest State Iowa’s mission, she said. 

“For instance, there are a lot of foundations across the state that focus on health and wellness. How can we connect them with the communities that we are working with, because funding for projects is always a challenge. … We all have limited resources, so we can’t do this in a silo. We have to do this collectively.”

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Healthiest Ames takes its own path to better health 

When Ames lost its bid to become a Blue Zones Community, leaders there decided they had invested too much time and effort not to move forward. 

The organization’s efforts in developing the city’s own wellness outreach program, Healthiest Ames, have earned it recognition alongside the original 15 Blue Zones communities as a founding Healthy Hometown communities. 

“We reached out to Wellmark and said we have a lot of individuals with this grass-roots effort across the community, but we need some direction,” said Stephanie Downs, board secretary of Healthiest Ames. “At that point, Wellmark really became an important partner in moving forward with some of the different initiatives that we had.” 

The organization, which has since achieved nonprofit status, established four focus areas with goals for healthy food choices, physical activity, health condition awareness and community connectedness. 

Ames Mayor Ann Campbell said she has been impressed with the diverse group of community leaders — all volunteers — who have come together to make Healthiest Ames successful.

“I think there’s no doubt that it was the initiative of Blue Zones that was the impetus for getting this going,” she said. “We had kind of a sad party the night we were expecting to celebrate being selected a Blue Zones community and were not. I think the group had enough cohesion and enthusiasm to run with it independently.” 

Among its accomplishments, Healthiest Ames has hosted four open streets events for the community in the past couple of years, using funds from a matching grant it received from Wellmark for a Complete Streets project. That project also helped it to earn a Bronze award as a Bicycle-Friendly Community from the League of American Bicyclists. 

Another success was securing a Wellmark matching grant to resurrect a bicycle helmet program for all Ames third-graders that had fallen by the wayside for lack of money. In another project, Healthiest Ames worked with an Iowa State University student health promotion club to get e-cigarettes included in the city’s clean air ordinance that was passed in February. 

Looking ahead, Healthiest Ames has a pilot program underway for an initiative to install healthful vending machines at worksites. In another project, it plans to collaborate with ISU to pilot a home-based activity program to help older residents in Ames increase their level of physical activity. 

“We’ve got our hands in a lot of things, but all tied around those four focus areas that we defined several years ago,” Downs said. “I think we were sort of a pilot for Wellmark in working with communities that weren’t selected for Blue Zones but wanted to continue. I think our trials and errors and accomplishments were really pieces that went into Healthy Hometown.” 

Shelley Goecke, a Healthiest Ames leader with McFarland Clinic, said she looks forward to serving as a conduit for new ideas from Healthy Hometown to share with Ames employers.

“We’ve heard from them that they’re looking for those resources for their employees,” she said. “That’s been a base for Healthiest Ames from the beginning, being a conduit for sharing of resources. That’s been a staple for us.” 

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