Population-Level Health Initiatives Can Improve Health and Reduce Risk of Heart Disease in a Community

Findings from a 10-year research project show that implementing health initiatives at a population level can improve health and reduce the risk of heart disease for an entire community.

Implementing health initiatives at a population level can result in huge changes, according to the results of a 10-year research project, which has found that an entire community can improve its health.

Findings on the Hearts Beat Back: The Heart of New Ulm Project (HONU) published in Preventive Medicine showed that residents of New Ulm, Minnesota, were able to do a better job at controlling their blood pressure, low-density lipoprotein (LDL) cholesterol, total cholesterol, and triglycerides after health initiatives were implemented compared with matched residents from another rural Minnesota community.

As part of the study, researchers from the Minneapolis Heart Institute Foundation (MHIF) and Allina Health looked at heart disease risk factors and healthcare utilization for more than 4000 adults between the ages of 40 and 79 years from 2009 to 2015.

Through the initiative, MHIF and Allina Health implemented evidence-based interventions in healthcare and community and work sites throughout New Ulm. There were also changes made within the community’s food and built environments. The comparison community did not conduct similar interventions.

The project spreads educational lifestyle messages through direct mail, newspapers, cable TV, radio, billboard, social media, and email, as well as at restaurants, stores, schools, and churches; encourages social support and cultivates champions and key influencers to engage people; and highlights successes to inspire others and increase engagement.

Over the course of the initiative, the proportion of residents in New Ulm who had their blood pressure under control increased by 6.2 percentage points, whereas the comparison community had an increase of just 2 percentage points. As the cohort in New Ulm got older, the proportion of people with their cholesterol at goal decreased by 1 percentage point, which was better than in the comparison community, where there was an 8-percentage-point drop.

“These results, showing improved management of heart disease risk factors in the HONU community, provide good news from a population health research perspective,” Abbey Sidebottom, PhD, MPH, a principal scientist for Care Delivery Research at Allina Health and one of the authors of the article, said in a statement. “HONU is a great example of how an entire population can lower their risk for heart disease. Many people making small changes can have a greater impact on the rate of heart attacks than a few people making great changes.”

Both communities saw their 10-year atherosclerotic cardiovascular disease risk scores increase—again, this is something that happens as people age—but the risk scores increased less in New Ulm (5.1) compared with the comparison community (5.9).

The researchers believe that, if the trends seen in the study continue, New Ulm will have fewer myocardial infarctions, strokes, and coronary heart disease deaths over time.

However, HONU did not address all cardiovascular risk factors. Over the course of the initiative, blood glucose, body mass index, and smoking trends did not differ between the 2 communities.

In addition, the researchers noted some important limitations, such as the fact that there was no randomized controlled trial to evaluate HONU and the fact that the study occurred in a homogenous rural community that was 99.7% white and where the vast majority of residents get their care from 1 healthcare system. As such, the findings of the study may not be generalizable to other regions, and the approaches that worked in this study may not be feasible in an urban environment.

“One of our goals with The Heart of New Ulm Project has been to create a model for improving health that can be replicated in other communities, especially rural communities, and we’re excited that our experience and results in New Ulm can help guide other communities and health care organizations as they partner to improve the health of their population,” said Rebecca Lindberg, MPH, MHIF’s director of population health and director for HONU.


Sidebottom AC, Sillah A, Vock DM, et al. Assessing the impact of the heart of New Ulm Project on cardiovascular disease risk factors: a population-based program to reduce cardiovascular risk. Prev Med. 2018;112:216-221. doi: 10.1016/j.ypmed.2018.04.016.