Improved community health:

The Franklin county

success story: 05/18/2015

Location of Franklin County in the southwest corner of Maine

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I'm Rob Logan, Ph.D., senior staff, U.S. National Library of Medicine.

Here is what's new this week in MedlinePlus.

A sustained community health intervention resulted in some desirable heart disease prevention outcomes in a low income, rural, Maine county, reports a pioneering study and an accompanyingeditorial recently published in the Journal of the American Medical Association.

The study reports the results of an ongoing cardiovascular disease prevention program in Franklin county Maine, which began in 1970. The community-based program has emphasized a range of health educational interventions within schools, area hospitals and clinics, physician's offices, and community gatherings. Some of the campaigns strived to reduce the risk of high blood pressure, cholesterol, and diabetes. Other campaigns sought to reduce tobacco use, improve diet, and encourage physical activity.

The study's nine authors report more than 150,000 individual county resident contacts occurred during a 40 year period.

The authors compared heart outcomes within Franklin county over time and also compared findings with other counties in Maine. The authors write (and we quote): 'Franklin County is a sparsely populated, predominately white, rural county in west central Maine. Over the past 40 years, its residents became poorer and older, but its ratio of population to primary care physician(s) improved' (end of quote).

The study found the combined campaigns resulted in significant improvements in blood pressure and cholesterol control. The smoking quit rates also were higher in Franklin than other Maine counties during most of the study period.

The authors add the hospitalization rate per capita in Franklin county declined significantly compared to the state during much of the study period. Moreover, Franklin was the only Maine county with consistently lower (adjusted for household income) mortality rates across two sustained time periods, 1970-1989 and 1990-2010.

Overall, an accompanying editorial suggests the findings provide (and we quote): 'strong evidence of relative improvement in cardiovascular health behaviors and factors as well as reductions in cardiovascular and total mortality in Franklin compared with other Maine counties' (end of quote).

The accompanying editorial explains the study is not based on randomized control trials. In addition, the editorial's two authors note is difficult to tease out the impact of individual interventions on the comprehensive results of the sustained Franklin county campaign.

Yet, the editorial's authors note the Franklin county campaign suggests health interventions can be effective in geographically isolated areas with (and we quote) 'scant financial resources, limited health services infrastructure, and low levels of household income' (end of quote).

In short, the success of the campaign suggests community based health educational efforts can counter adverse health outcomes in geographic regions where disparities in income, health access, and ongoing health challenges exist.

The editorial's authors note (and we quote) 'this report… should reinforce the importance of cardiovascular health promotion and disease prevention policies and practices at the community level; stimulate efforts in communities to document and publish their past experience in this area to inform related ongoing work..' (end of quote). The editorial's authors conclude (and we quote): 'the experience deserves consideration as a model for other communities to emulate, adapt, and implement' (end of quote).

Meanwhile, MedlinePlus.gov's rural health concerns health topic page provides a number of helpful resources about health in less populated areas of the U.S. For example, the Rural Information Center explains what is rural in the 'overviews' section of MedlinePlus.gov's rural health concerns health topic page

A guide to promote wellness and prevention in less populated areas (from the Rural Assistance Center) is available in the 'prevention/screening' section of MedlinePlus.gov's rural health concerns health topic page. More specific guides from the Rural Assistance Center (available in the 'related issues' section of MedlinePlus.gov's rural health concerns health topic page) provide information about rural health disparities, as well as specific topics such as rural substance abuse, and availability of rural health clinics.

MedlinePlus.gov's rural health concerns health topic page additionally provides links to the latest pertinent journal research articles, which are available in the 'journal articles' section. You can sign up to receive updates about rural health as they become available on MedlinePlus.gov.

To find MedlinePlus.gov's rural health concerns health topic page, type 'rural health' in the search box on MedlinePlus.gov's home page, then, click on 'rural health concerns (National Library of Medicine).' MedlinePlus.gov also has health topic pages devoted to farm health and safety as well as health disparities.

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