The document discusses the rising burden of chronic health conditions in the U.S., which are driving healthcare costs and affecting a significant portion of the population. It introduces a behavioral pharmacy model aimed at improving health outcomes through experiential and community-based interventions, emphasizing the importance of desire and habit change. The model has shown promising results in various settings, including community health efforts and corporate wellness programs.

1. E L I Z A B E T H M A R K L E , P H . D .
H E A LT H C A R E E X P E R I E N C E D E S I G N
4 / 2 / 1 9
Truth, Desire, and Habit:
Animating Community
as Medicine

2. Chronic, Progressive, and
Preventable health conditions
are driving human suffering and
skyrocketing health costs.
• Depression
• Diabetes
• Cardiovascular Disease
• Social Isolation
Things you already know . . .
Source: www.truehealthinitiative.org
86%of our nation’s healthcare costs are
spent treating people with chronic diseases.
100+ MILLION Americans are projected
to be diabetic by 2050.
70MILLION Americans have hypertension,
with elevated risk for stroke and heart attack.
70%of all Americans are overweight or obese.
130+MILLION Americans are affected by
chronic diseases – that’s 40% of the population!

3. GOOD LUCK
WITH THAT,
I’LL SEE YOU
IN 6 MONTHS!

4. The Behavioral Pharmacy

5. What’s Different?
1. Experiential: We don’t just TALK about
health behaviors, we DO them.
2. Trans-diagnostic: Diabetes, Obesity,
Cardiac Disease, Depression, Metabolic
Syndrome, Social Isolation . . .
3. Culturally-flexible: Turnkey
implementation
4. Powered by Connection: Coaching,
Small-group relationships, Peer
Leadership
5. Democratized: <1/5 the cost of the highly-
effective Ornish Lifestyle Medicine
program.
6. Place-Based (!!)

6. MOVE

7. TRUTH
DESIRE
HABIT

12. Work Performance
Work Relationships
Work-life Balance
Exercise
Mental / Emotional Health
Personal Relationships
Nutrition
Stress Management
Social Life
Spiritual Well Being
Meaning, Purpose
Recreation
1
GET HONEST

13. “Desire is the only
power source
potent enough to
effect change.”

14. SHIFT FROM
“WHAT’S
THE MATTER
WITH ME?”
STEP 2
SOURCE
DESIRE

15. TO
“WHAT MATTERS TO ME?”

16. TRUTH +
DESIRE =
VITALITY

18. Are we done here?

19. Your LIFE is composed of habits.
Your current habits won’t get you what you WANT;
they will get you what you HAVE.
Change requires a structure for fulfillment.
STEP 3
HACK YOUR HABITS

20. What Habit Do You
Most Want to

21. THE GOOD NEWS
1.GET HONEST
2.SOURCE DESIRE
3.HACK YOUR HABITS
THE GOOD NEWS
GE T HONE S T
S OURCE DE S IRE
HACK YOUR HABIT S
1
2
3

22. Implementation to Date
§ Clinically-Integrated: Hayward
Wellness Center, Alameda Health
System
§ Community-Based: In Oakland,
CA, with Prevention Institute
§ Low-Income Housing: Alameda
Point Collaborative
§ Corporate Employee: Genentech,
Alameda Alliance for Health

23. Diet and Exercise
Clinical model, n = 55
5.0
5.9
0
1
2
3
4
5
6
7
d = .34
Fruits and Vegetables
Daily Servings
Pre Post n = 55
81.9
122.9
0
20
40
60
80
100
120
140
d = .43
Exercise
Weekly Minutes
Pre Post n = 55

24. Depression, Anxiety, and Isolation
(PHQ-9, GAD-7, UCLA Loneliness Scale)
PHQ-9 GAD-7 UCLA
14.4
10.4
6.4
9.8
8.3
5.6
0
2
4
6
8
10
12
14
16
Depression Anxiety Isolation
Pre Post

25. Blood Pressure
PHQ-9 GAD-7 UCLA
150
82
131
77
0
20
40
60
80
100
120
140
160
BP Sys BP Dia
Pre Post

26. Acute Care
PHQ-9 GAD-7 UCLA
22
5
0
5
10
15
20
25
d = -.53
ED Visits/Hospitalizations
6 months prior to group
6 months following group n = 49

27. A Model and a Movement

28. What Does It Look Like?

29. C O M M U N I T Y
I S M E D I C I N E

30. ELIZABETH MARKLE, PH.D.
LIZ@OPENSOURCEWELLNESS.ORG
THANK YOU!