When Ben Franklin, during the heady atmosphere of the signing of the Declaration of Independence on July 4th, 1776 warned those present that “We must, indeed, all hang together or, most assuredly, we shall all hang separately,” he was reminding everyone that the success of the Revolution was anything but assured, many obstacles stood in the way, not least of which was Great Britain, the mightiest empire the world had ever known, which was known to deal harshly with those who opposed it’s rule.  Optimism is a good thing, but it must be tempered with a dose of reality.  No-one knows this better than physicians; everything we see, everything we do, has a measure of morbidity and mortality.

Let us consider present-day Saginaw.  Things are looking up.  The hospitals are busy, the factories are humming, employment is up, CMU is here, Dow is here; Delta and SVSU are here.  Ours is a great community, with a rich history, strong institutions, forward-thinking leaders, rich family ties.  We should be optimistic about the future, right?  Sure, but, like Ben Franklin in 1776, we must to be realistic as well.  We face serious challenges.  Our profession is still in crisis mode.  Our community, in many ways, is also in crisis mode, facing an aging population, an opiate crisis, stagnant wages, poor educational achievement, and an epidemic of chronic disease caused by poor health habits.

Traditionally, our job as physicians has been to manage the 20% of the economy that deals with health care and it is the job of everyone else, government, business, foundations, etc, to deal with the other 80%.  Nothing’s that simple, however.  That 20% and that 80%, it turns out, are ever-so-tightly intertwined such that they affect each other in complicated and myriad ways.  Consider a few:

  • Unemployed persons are challenged to eat, sleep, and exercise in healthful ways, thereby getting sick more often, putting a strain on the medical system…you.
  • Persons with poor educational achievement don’t understand anatomy, physiology, pharmacology, self-care. They make poor patients.  They also make poor workers, so businesses cannot grow.  Our community as a whole suffers.
  • Unemployed, poor patients, stressed patients have more pain, then they overuse and become addicted to opiates, with all that entails.
  • When a sick person doesn’t get proper medical care, for whatever reason, and can’t work, then his employer loses the ability to compete in the global marketplace, and may fail.

The point is, that medical care and the economic health of the community are intertwined.  This has been obvious to many of us over the years, but has finally started to gain traction amongst community leaders in the last couple of years and has culminated recently with the formation of a “multi-stakeholder” initiative THRIVE (Transforming Healthcare Regionally in a Vibrant Economy).  The acronym is quite appropriate…we all know that we need to transform the healthcare business, and we all know that working on healthcare alone, unless patients have jobs—good jobs, will never be successful.  THRIVE brings together the full force of regional businesses and healthcare organizations, mixing in some serious money and cooking up a vigorous effort at solving our economic and health issues AS A WHOLE rather than piecemeal.

For instance, we now have a list of 35 separate needed interventions.  That is a lot!  But, fortunately we also have amassed a vast database of health and economic data, as well as a sophisticated computer simulation that models what happens to the entire community when money is allocated to a single effort, such that we can get the most bang for our buck.  I’ve been following these efforts and am quite impressed.  In fact, I have volunteered to write a regular Internet Blog detailing the project as it goes forward.  Other SCMS physicians involved include Tom Veverka, Cathy Baase, George Kikano, and Sam Shaheen.  The success of this enterprise is anything but assured, but I am expecting that the wonderful people in our medical community will assuredly “hang together” with the wonderful people in our community as a whole, and I am optimistic of our ultimate success.


About Dr. Louis Constan
Dr. Constan grew up in Chicago, came to the Great Lakes Bay Region in 1972 where he trained in Family Medicine and fell in love with this community.  At heart, he is an old-fashioned country doctor who, during his career, made house calls, delivered babies, set bones, and did surgery; but was never afraid to get involved in creating hospital policies and supporting academic medicine through teaching medical students and Resident doctors.  Along the way Dr. Constan has received many honors, including Family Physician of the Year for Michigan in 2006, and the Governor’s Award for Excellence in 2005.  He considers health education one of his prime roles, is a frequent community lecturer on health topics, has been published in many newspapers and magazines, and is proud to be able to continue doing so for Michigan Health Improvement Alliance (MiHIA) and their shared THRIVE initiative.