Salus Health Care Forum: November 5, 2025

My wife, who happened to be an exercise physiologist by training, and the other docs and nurses in town put our heads together and came up with this walking-in-wellness program. This program was actually based on activities that had been done on the Hopi Reservation several years earlier. It got to the point where one of the local WAGs would write the weekly newspaper op-ed column saying: We’ve got so damn many people walking each morning that we’re going to have to put up additional traffic light. It really did get people moving. It changed, in many ways, the attitude in the community, a sense of possibility, because people were actually feeling better. Exercise is a pretty reasonable treatment for at least mild to moderate depression. I took those lessons.

When I arrived at Wisconsin, Gene Farley was my chair. Gene was hoping that this new rural practice would become what he called the Framingham of family medicine studies. We never really had the critical mass of patients or the right people to make that happen in a rigorous scientific way, unlike what they had available in Boston.

We initiated a number of projects, a community-oriented primary care project, trying to find ways to engage the community and take on health issues at a community level. I think along the way, the lessons that I’ve learned is that these boundaries that we create, especially in the United States, are much more distinct and dysfunctional than what you see in other parts of the world. Where there’s a cleaner, better interplay between the community health sector, public health sector, private or personal health sector, and mental health. All the components that go into creating a good health system. We just don’t do that very well here.

You hate to put it down to money, but a lot of it has to do with money. There has historically not been a lot of money in public or community-based programs. We’ve always been, as a country, I think, hesitant to put much money into these programs, because that’s tax dollars. And who wants to pay more taxes? For me, the only way forward is to create a system that’s more person-centered and community-based.

Bill B

I wonder, Jack, you have been doing a lot of research in this area.

Jack

I want to thank Jeremy for bringing the National Academy of Medicine’s report to this group. I have to say, I find the report, and particularly the preface and background, profoundly disturbing and disappointing, but not surprising.

I think there’s so much here that is just outside the scope of actual lived experience. It points out that part of the issue in America right now is this disconnect between people who write National Academy of Medicine reports and people who live in communities.  I’m posting the 50 worst places to live in the United States. Some of them are in my neck of the woods, where I do research. I think some are where Rich used to work and live as well.

The people who live in these communities find this language horrible. The people living in these communities hate the county rankings. The people that live in the counties that I work in are at the bottom of the county rankings. They respond: Who said you could rank us? And, I think, if you ask the people in these 50 counties where the worst place to live in America is, it would not be their county. It would be Washington D.C., where the National Academy is centered. I think there’s a big disconnect between this concept of value and quality. And part of it has to do with the deficit-based approach to people’s lives.