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The HICCup Manifesto

NEW YORK – It is hard to find anyone in health care who does not believe that spending $100 now on healthy behavior – exercise and proper nutrition, counseling for pre-diabetics, risk monitoring, and so on – could yield more than $200 in reduced costs and improved outcomes later. The numbers are fuzzy, of course, and there are plenty of methodological caveats, but there is little dispute about the desirability of such an approach.

And yet neither individuals nor communities seem to act on the basis of this knowledge. Individuals often lack willpower or access to healthy food or convenient exercise facilities, and are surrounded by poor examples that encourage instant gratification rather than effort and restraint. And, on a broader, institutional scale, the money spent and the money to be gained do not belong to the same pocket.

Instead of just complaining, I recently decided to create HICCup, the Health Intervention Coordinating Council, a self-appointed counseling service aimed at persuading local institutions to embrace a long-term perspective and launch a full-scale intervention in their communities. For practical reasons, there are a few guidelines – but anyone who wants to do this without following our rules is welcome to do so.

For starters, HICCup will focus on communities of 100,000 people or fewer. The majority of the community and its institutions must be enthusiastic. If most community members work for just a few employers and obtain health care from just a few providers, the effort of corralling the players will be easier. And, of course, community leaders – the mayor, city council members, and others – must work together rather than undermine one another.