It is early days, but investors in a unique health promotion experiment are bullish.
A six-month regime of personal coaching, exercise and healthy eating sponsored by the Heart and Stroke Foundation of Canada has succeeded in keeping blood pressure in check — without drugs — for several hundred Toronto-area adults at risk of developing hypertension. Doug Purdy, 73, walks his Wheaten terrier Chloe near his home in the Keele and Finch area. Purdy says he’s lost 16 lbs. since he signed up for the Heart and Stroke Foundation’s Activate program aimed at curbing high blood pressure. The three-year, $3.4 million project that will eventually involve 7,000 participants in the GTA and Vancouver was launched last year as Canada’s first health-related social impact bond, or “pay-for-success” initiative.
Results for the first 500 enrolled last May are “very exciting,” says Heart and Stroke senior manager Erin Kim, who is leading the “Activate” project in partnership with the MaRS Centre for Impact Investing.
Eleven private investors, including businesses, charitable foundations and wealthy individuals, are funding the initiative through the MaRS Centre. The Public Health Agency of Canada will pay up to $4 million depending on how many participants are recruited, complete the program and see their blood pressure stay the same or go down.
Hypertension is the leading cause of stroke, a key risk factor for heart disease and one of the most common reasons for a person to see a doctor and be prescribed a drug, says Kim. It affects more than 6 million Canadians and costs the health-care system more than $14 billion a year.
Left untreated, half of Canadians over 60 with blood pressure in the “high-normal” range (121-139 systolic/80-89 diastolic) will develop hypertension within four years.
In the first cohort, more than 90 per cent stuck with the program for the full six months. And blood pressure readings for a sample of 100 of the first 500 participants showed an average 5.2-point drop. It means some participants moved their blood pressure readings from “normal-high” to “normal” — a significant finding for a drug-free intervention, researchers say.
Heart and Stroke is enrolling its second cohort of 4,100 participants from across the GTA between January and May. Another 2,400 participants in Vancouver will be signed up in 2020.
If the prevention initiative keeps average blood pressure stable for all 7,000 participants during the six-month program, Ottawa will pay the MaRS investors a return of 6.7 per cent. If the program overshoots this target and average blood pressure goes down, investors will receive an 8.8 per cent profit, or $600,000 in total. If the program fails to meet its goals, investors lose most of their money.
“Health promotion is hard. But it’s much better for individuals and society to adopt healthy lifestyle changes and prevent high blood pressure and the need for medication,” Kim says. “And that’s what this program is trying to demonstrate.”
Most of the support is provided through the Heart and Stroke’s “Activate” website and a specially designed app which includes coaching, health information, recipes, mindfulness training and goal setting, says Kim.
Participants with elevated blood pressure must be over 40, non-diabetic and not on medication for hypertension. Once enrolled, they are encouraged to keep a daily log of what they eat and how much exercise they get. The program includes free access to a Loblaws dietitian, a two-month YMCA membership and opportunities to meet others enrolled in the project through periodic community events. Participants receive PC Optimum Points as a reward for healthy behaviour.
The six-month program aims to help participants make “small, healthy choices” to help prevent the onset of high blood pressure, Kim says.
Toronto retiree Doug Purdy, who lost 16 lbs. “and two belt loops” between May and October, says the program changed his life.
“I always had good intentions about exercising. But this helped me get with the program,” he says.
Purdy, 73, credits his Wheaten terrier Chloe and a new exercise partner he met at the YMCA for keeping him on-track. He became so accustomed to working out at the Y, that he took out his own membership when the two-month free trial was up.
“My blood pressure is down to normal now,” he adds.
Regular exercise, along with healthy shopping and eating also produced positive results for Mississauga accountant Babatunji Farinloye, 50.
“I had a health club membership, but this program really helped me develop a habit,” he says. “Now, if I don’t work out, my body feels like something is wrong.”
A grocery store tour along with instructions from a dietitian on how to read product labels, “was a real eye-opener” Farinloye says.
“No more white bread,” he says with a laugh. “I am eating a lot more vegetables, especially colourful ones.” Mississauga accountant Babatunji Farinloye, 50, says he’s happy with the positive results produced by regular exercise and healthy eating since he became part of the Heart and Stroke Foundation’s Activate project. Elementary school teacher Teresa Galati, 56, says the program has helped her manage stress — and her elevated blood pressure.
“I have learned how to take time to meditate and it really helps,” she says.
Galati found the personal coaching particularly useful.
“I was able to go online and ask questions and even if my coach wasn’t available, someone always got back to me,” she says. “If you don’t have time to meet with someone, it’s great to be able to go online. It was phenomenal.”
Investors are also happy.
“We are very pleased with how the first cohort worked,” says MaRS director Adam Jagelewski. “We are setting ourselves up for the second and third cohorts that will ultimately dictate whether investors will get their returns or not.”
While some critics say government should not be paying a “middle man” to deliver public health and social services, Jagelewski says the pay-for-success premium makes everyone involved work harder and allows public officials to show taxpayers what their money has been able to accomplish.
“It doesn’t have to be a social impact bond,” he says. “Outcome-based contracts that have rigour around outcomes-based measurement are where we ought to be going generally.”
A social impact bond using private investors to take on the risk is just one way to do it. Governments could just as easily take this approach, he adds.
“The question is how can we learn from the way this program was designed and apply it to diabetes and other chronic disease and even mental health and addictions,” he says. “I’m hoping this program is a beacon of light for preventative programs across the board.”
As Heart and Stroke gears up to enrol its next cohort, the foundation is inviting employers, unions, health care providers, community associations and other groups to encourage their staff, members, patients and clients to join the free wellness program. Staff from Loblaws, Shoppers Drug Mart and CAA Club Group have already participated and Deloitte and others are on board for the next cohort, Kim says.
For employers with more than 500 staff, Heart and Stroke will send volunteers to the workplace to measure blood pressure and enrol those who qualify. Those who don’t qualify still get access to the foundation’s health resources and a free two-week YMCA membership.
“As everyone knows, a healthier workforce is a happier workforce, with less days off etc.,” Kim says. “We are really keen to know if corporations would spread the word for us because it could really benefit them too.” Play Video
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