The idea is not new. Dr. Milton Mazer had it some 30 years ago when he did his paradigm social psychology study on the Island that resulted in the book People and Predicaments. Dr. Felton Earls had it a few years later, when he launched a long-term study of how Island children handle stress.
But the concept of the Vineyard as a laboratory for understanding human health got a fresh start this week when the Robert Wood Johnson Foundation awarded a $50,000 grant to a start-up Island foundation with an innovative mission: to design and test a comprehensive community-centered health care system.
"Ultimately all health care is local," declares the mission statement for The Foundation for Island Health.
"The Vineyard is a model place to test these solutions," said Dr. Charles Silberstein, a Vineyard psychiatrist, in an interview with the Gazette this week. Dr. Silberstein is the chief executive officer and a charter member of the Foundation for Island Health.
Established in August of 2000, the foundation is aimed at creating a patient-centered, self-funded community health system that is wrapped around prevention, education and state-of-the-art technology. Dr. Silberstein and the other members of his foundation believe that the Vineyard - with its relatively stable year-round population and unusual diversity for a community so small in size - is the perfect place to test their visionary plan.
"This is a big vision - to take health care out of the context of a single institution like a hospital and put it in a whole network of people in a community, from physicians to neighbors," said Rosabeth Moss Kanter, a Vineyard resident and Harvard business school professor who is a member of the advisory board for the foundation. Ms. Kanter has published numerous books on a wide array of business and economic topics. Her latest book, Evolve! is about the internet culture.
Based in Princeton, N.J., the Robert Wood Johnson Foundation is the nation's largest philanthropy devoted exclusively to health and health care. This marks the first time the foundation has awarded a grant on the Vineyard.
The $50,000 grant is a core-service grant, which means the money will be used to launch the basic components of the project, including a feasibility study and a business plan.
"This is an experiment that could attract national attention as it goes forward. We are encouraged by the energy and thoughtfulness that has emerged from within the Vineyard community to take on this challenge," said Frank Karel, vice president at the Robert Wood Johnson Foundation.
National statistics tell part of the story. Of the $1.2 trillion spent on health care each year in the United States, 88 per cent of the money is spent on health care access, while only four per cent is spent on health behaviors.
The Foundation for Island Health envisions a system that is the flip side of the traditional system: prevention-driven, patient-centered, unfettered by government bureaucracy and supported by some of the most sophisticated technology of the day.
Sound too far away and dreamy?
The foundation doesn't think so, and its prospectus is an information-packed primer on the project.
The prospectus outlines the population demographics of the Island community and its relatively simple health care system, anchored by one hospital, one nursing home, two home care agencies, one hospice organization and fewer than 30 physicians.
"True health care is a product of healthy community life, adequate medical care, education, healthy lifestyles, nutrition, exercise, a clean environment, safe housing, nonviolence and loving, supportive relationships," the prospectus declares in part.
Dr. Silberstein said the seeds for the foundation began about a year and a half ago following a talk on the Island with two health-care experts: Judith Kurland and John McKnight.
It was the second visit to the Island for Ms. Kurland, who has inspired views about prevention and creating healthy communities. At the time, Ms. Kurland said the Island would be a perfect place to test a new model system.
Dr. Silberstein said the foundation also drew its inspiration from two real-life models and established Island programs that operate with no government subsidy: Hospice of Martha's Vineyard and the Vineyard House.
"Both are organic community efforts to solve a health problem, and both emphasize community action and are funded through community action rather than third-party payers," said Dr. Silberstein.
The foundation already has four projects under way:
* A school health curriculum at the Martha's Vineyard Regional High School aimed at stemming a documented high rate of risky behaviors among Island teens.
* A health care advocate program aimed at providing professional health care advocates for every Vineyard resident.
* A community-based medical information system and pharmacy system on the web.
* Work to secure licensing in Massachusetts for a state-of-the-art CAT scan machine that permits sophisticated, non-invasive, full-body screening for cancer and other diseases.
The grant will take effect on August 1. Immediate goals include developing a feasibility plan and drawing attention to the model at a summer symposium planned for August 12 at the Old Whaling Church in Edgartown. Ms. Kurland will be one of the speakers at the symposium.
The foundation also hopes to secure a grant to fund the school health curriculum project, and it wants to raise $1.2 million between Oct. 1 and September of 2002. The money will help to get the initial projects off the ground, launching some of the starting pieces of the model health system. Some money will also go toward hiring an executive director for the foundation.
Dr. Silberstein said he does not think the fund-raising goal is unrealistic, and he countered the popular notion that there are too many worthy nonprofit projects on the Vineyard - all competing for the same donor dollars.
"I think there are lots of funds on this Island for exciting projects - look at the Vineyard House, it was an exciting idea, it seemed right, and do you think that the money that was donated for that project would have been spent somewhere else? Not a chance," he said. He continued:
"The Robert Wood Johnson Foundation got interested in this because it has the potential to be a model for other places. I think that the idea that there is a limited pot of money that everyone is competing for is wrong - because we are a community and we have tremendous resources and we have barely begun to tap them."
He cited the foundation creed, which he credits to the late Mike Svirdoff: Do concrete projects, do it on a local level, and do everything in collaboration.
"These are the guiding principles for us," Dr. Silberstein said, pointing to the need for close work with other health care organizations, including Martha's Vineyard Community Services, the Martha's Vineyard Hospital and the Dukes County Health Council.
"There is a way we can realize this dream, especially if we are working together. Part of our vision is to demonstrate the public health impact of healthy activities. This has the possibility of opening doors for the whole health care community on Martha's Vineyard," he said.