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Investing in Health on the Community Level: A Talk with Wellville's Esther Dyson

Esther Dyson is a health evangelist, VC investor, AND trained cosmonaut. She was on the board of Evernote, Meetup, and 23andMe as well as an investor in Flickr, Square, and Jump (just acquired by Uber).

She's recently been working on Wellville, a non-profit project she started designed to help improve health on the community level as a way to influence policy at scale. Let’s see what she has to say...

Hi Esther, thanks so much for talking to me today. Want to start by explaining your rather incredible background?

Well, I started out as a fact-checker for Forbes, which taught me the very important craft of asking questions and not being satisfied with the first answer. Then I went to Wall Street, got very involved in the tech industry and for 25 years ran a newsletter and conference focused on what began as the PC revolution and then grew into the internet and social networks and so forth.

Then, I began to wonder if this tech stuff is really useful and so I got into health care as an angel investor. I then started wondering why we were fixing things that shouldn’t have been broken in the first place, and that ultimately led me to start Wellville, which is a ten-year project (through 2024) operating in 5 US communities to show the value of investing in health.

"Short-term motivation is addiction and long-term motivation is purpose."

So, I’ve been doing that for five years and have learned a ton, including a lot about motivation. Short-term motivation is addiction and long-term motivation is purpose, and the challenge is raising children so they have a sense of purpose rather than a vulnerability to addiction. That’s what we’re trying to do in our communities now. Focusing on early childhood and also on the parents…and all these things interact. If the parents are happier than they’ll be better parents, and if the children have better food then everything improves. So we’re working in these five communities of under 200,000 people each to actually demonstrate the value of these investments. You can’t just say science proves it, because it’s much more persuasive having actual examples to point to. Our ultimate goal is for other communities and investors and policymakers to copy us, not for us to scale ourselves.

You noted the importance of involving communities and connections among people for your programs. Is the use of networks for improving health the intention there?

Well, it’s not the intention; it’s the mechanism. We knew that having different parts of the system interact positively is the only way to make this happen. You can’t fix a systemic problem by fixing only one corner of the problem.

You also can’t fix everything but if you fix one or two things that interact, then it can have nice network effects that spread.

I know the communities have various focusses, from smoking cessation to obesity reduction. How did you help them choose them?

The communities choose these for themselves. We give them advice, pointing them to scientific evidence or to potential partners. But really, it’s kind of like having a gym coach. In the end you’re the one who has to get up at 5 am. It’s still their community, so first they have to own the problem and then they have to own the solutions because if not, nothing will last. So, we’ll tell them what we think but it goes back to the whole point of Wellville: not to bludgeon people into agreeing but to show them evidence that’s persuasive.

We don’t give them money but we also don’t charge them. The moment you give someone money they start listening to you perhaps too much. Not giving them money in a sense keeps us honest because we can’t just give them money and make them do what we want. ,

It seems like your Wellville dream is inspired partly by looking at health care and seeing what really didn’t work. What do you think is the hardest part of making preventative health work out?

People start too late. “Preventative health” usually means there’s already a problem. The place to start is creating health, not reducing illness. It means giving children the capacity to think long-term and do what’s good for them and have a sense of security rather than be damaged and need instant gratification, which makes them vulnerable to addiction and other challenges.

"The place to start is creating health not reducing illness."

So it's holistic health?

You can call it whatever you want, but that term has too many associations I would reject, including expensive spas and exotic supplements.

Instead, imagine I go running.

I’m not a very good runner, it’s a bit stressful, but it makes me healthier. If someone very unhealthy goes running it will harm them. But an appropriate amount of running for my capacity causes stress that is beneficial and increases my resilience. Minor stress is actually usually good, a little bit of stress. People have discovered that if you don’t feed a kid peanuts it’s not going to save them from a peanut allergy; it’s probably going to foster it. So, just like with a vaccine, introducing a little bit of stress to helps develop specific resilience to it.

And that’s why we need to challenge ourselves… Getting back to this long-term purpose idea, the happiest person in the world isn’t the one who is always successful, but the ones who face challenges, overcomes them and goes on to do more and really does become a stronger.

There’s a wonderful book on this topic called Anti-Fragile by Nassim Nicholas Taleb, the guy who wrote the Black Swan. It’s a really wonderful book!

You talk about wonderful ways communities are beginning to invest in long-term initiatives and foster motivation. On that note, what initiatives have you found really haven’t worked and you’ve had to learn from them?

Well, this is sort of ironic. We did a flu-vaccination campaign in Muskegon, and it was us really pushing it rather than the community being enthusiastic about it. We learned a lot about not pushing people to do something if their heart’s not in it. In the end, they did the campaign and got a few more people vaccinated against the flu, but they didn’t value it enough to do it again this year. It was not what I hoped for, reinforcing that message that you should let the community be the driving force - and we just help with advice.

"These aren’t problems you can solve while locked in a room. They need to be solved with real people in the real world in real circumstances."

Overall, there are so many different things you can do, like diabetes prevention, anti-smoking, childhood education, prenatal care, mental health….. These things all contribute and to some extent if any of them contribute to that feeling of facing a challenge, and learning to work together and take responsibility, then that's success that spreads so they can take on other challenges. It doesn’t matter where you start as long as you keep going - and learn and fix things along the way!

It’s not that there’s one right thing and doing anything else is wrong, but our perspective is there’s a range “right things” you can target and doing three of them effectively is awesome. Doing five or ten of them well in the short run is probably impossible because you need to focus.

Do you often get to meet the people in the communities?

Well we’re not out in the streets, but we’ve gotten to know lots of people and have dinner with them and so on. But it’s not our role to be visible in the community; that’s the role of the local leaders we work with. To some extent the more necessary we are, the less scalable what we’re doing is. If you need us in particular to do these things, then fundamentally it can’t scale. We’re not fancy consultants, we really are just a coach, an advisor or a court jester. They have the power….and the accountability.

Have you seen or thought of any really interesting for-profit models for investing in health as well?

The for-profit models are clear – for example, training programs, prenatal care, caregiving services, daycare…. but the thing is who pays those companies? I really think it’s going to be society at large, ultimately, taxes and local governments. I would also argue that more employers should start paying not just for health care but for training and education of their employees. Just like individuals, they should think long-term and with purpose!

There was this article about two janitors, one at Eastman Kodak way back in the day who was a janitor but had good employment benefits such as education. She took advantage of them and ended up as the CTO. The second janitor is currently working at Apple, she comes late in the evening and rarely meets anyone there. She works for a contractor of Apple and has no education benefits and probably no health care. And as far as Apple is concerned they have no interest in investing in her. As the story concludes: “They both spent a lot of time cleaning floors. The difference is, for Ms. Ramos [at Apple], that work is also a ceiling.”

Do you have any must-reads you think young people should check out if they’re interested in health care?

Yes, the Biology of Desire by Marc Lewis, about what I mentioned around short-term and long-term desire.

All the books by Siddhartha Mukherjee, like The Gene and The Emperor of All Maladies. Thinking Fast and Slow by Daniel Kahneman, and Scarcity by Sendhil Mullainathan and Eldar Shafir.

As we finish, what’s been the worst pitch you’ve ever gotten?

Uber for shoe shines – not as a pitch, but as a concept. There’s some that are so un-compelling I don’t remember them, but that’s the one I cite as an example. Another recently was CoinBnB which is BitCoin for rentals… It used to be you could say anything was ‘Uber for….’ to get investment and now it’s like you just need to add ‘Coin’ or ‘Blockchain’ somewhere.

And what would you recommend to a young person interested in health care?

Well if they want to disrupt health care, they should work in health care a few years before trying to disrupt it. Find someone who’s been around for a while, because these aren’t problems you can solve while locked in a room. They need to be solved with real people in the real world in real circumstances. And if they want to work in health, well, go back and read the rest of this!

Love that advice, thanks so much.

Learn more about Esther and Wellville

Next Up:

Conversations from HLTH, a new conference focussed on the future of healthcare.

#healthcare #nonprofit #healthpolicy #preventativehealth