Skip to Main Content

Microclinic: Simple Solutions for Complex Problems, Part 1

Microclinic: Simple Solutions for Complex Problems, Part 1

Microclinic: Simple Solutions for Complex Problems, Part 1

Dr. Tuckson's guests are Daniel Zoughbie, Ph.D., founder and CEO of Microclinic International, and Eric Feigl-Ding, Ph.D., chief health economist for Microclinic International and an epidemiologist and health economist at Harvard T.H. Chan School of Public Health.
S15 E12 Length 27:26 Premiere: 1.19.20

Microclinic’s Innovative Model for Improving Public Health

Microclinic International is a nonprofit organization that developed a model built on social and community networks and has applied it worldwide in areas where chronic disease is widespread. In 2011, Microclinic launched its first program in the U.S., deep in the heart of Appalachia, after being approached by Louisville-headquartered health care company Humana. The partnership operated a program in Bell County in eastern Kentucky and targeted two chronic health problems plaguing the county and overall region: obesity and Type 2 diabetes.

Microclinic and Humana reached out to the community and public health department in Bell County to seek out their input, and developed a randomized control trial for citizens. One group participated in the Microclinic model, which educates community members to adopt healthy lifestyles and, just as importantly, trains them to educate, motivate, and support other community members. Another control group received no intervention.

“The randomized trial that no one’s ever done in rural Kentucky before was, we did this for nine months and gave people this intervention,” says Eric Fiegl-Ding, chief health economist for Microclinic. The results were remarkable: according to Fiegl-Ding, participants in the Microclinic lost on average six pounds compared to community members in the control group, they improved their blood sugar, and they lowered their blood pressure. More importantly, participants kept the weight off, even up to a year after the program ended.

A Paradigm Shift from Treatment to Prevention

Microclinic founder and CEO Daniel Zoughbie says that he was inspired to create his health care nonprofit after watching his grandmother die prematurely from diabetic complications. He kept track of her struggles managing the disease and came to realize that all of the hardship she endured could have been avoided had she existed in a community where good health care practices were well-established and part of the social fabric.

“My grandmother’s death could have been prevented had she received important information that could have helped her change her lifestyle, but also if she had had people around her who could have helped her change what she ate and how much she exercised,” he says.

Fiegl-Ding also has a family history of diabetes. He has an academic background in epidemiology – the practice of studying how diseases spread and how to control them – and believes that the central tenets of epidemiology are crucial in reducing incidence rates of diabetes.

“We realize that 90 percent of all diabetes can be prevented by diet, lifestyle modification, and all these simple things we are not doing,” he explains.

The bedrock principle of Microclinic is that such modifications in diet and lifestyle are best achieved on a wide scale if they become adopted – and crucially, endorsed – by the patient population. Having a doctor advise a patient to change his/her diet and exercise habits is one thing. Having family members and friends apply positive peer pressure is much different.

To that end, Microclinic educates community members with an emphasis on collaboration and empowerment. Their program enlists area hospitals, clinics, physicians, public health departments, and even grocers in the cause, which is nothing less than effecting a paradigm shift in how health care is administered within a community.

“As a nonprofit organization, we stand in the intersection of many different players,” Zoughbie says. “And what our message is, everybody needs a seat at the table. The payers, the providers, we need to re-align the incentives so that when people don’t go into emergency rooms, when people don’t need to seek health care at overburdened public health clinics, everybody is benefiting.”

Changing the modern health care system from one focused on treatment to one on prevention is a complicated and arduous task, but well worth it in the end, Zoughbie and Fiegl-Ding argue, and the results of Microclinic’s efforts in places ranging from the Middle East to Bell County prove it.

“Our current structure is very reactionary,” Fiegl-Ding says. “When people get sick, then we get them insulin and other drugs and bariatric surgery, and put them on kidney dialysis if their kidneys are failing. It comes down to planning – we want to prevent a disease, but all of our financial incentives are currently aligned with treatment.

“In public health, we know that an ounce of prevention is worth a pound of cure,” he continues. “But how do we align our incentives so that if you prevent 1,000 diabetics in eastern Kentucky, that will actually be shared and invested in more prevention?”

“Good Health Is Contagious”

“I think that we’re accustomed to think about health in terms of the individual, and the individual biology of a person,” Zoughbie says. “We’re not accustomed to thinking about the sociology of diseases – how do social structures make individuals sick, how do the built environments around them make them sicker, and conversely, how can we actually use social relationships, social networks to prevent disease by changing simple behaviors.”

Zoughbie points out that much research has been conducted on how negative behaviors – from substance use to gang violence – are spread through social networks and peer pressure.

“You know what? Good health can be contagious, too, and it can spread through networks,” he says. “And public health systems, insurance companies, and communities can work together to propagate the spread of good behaviors.”

The decades-long effort by public health officials in the U.S. to reduce smoking is an example of an effective social network model. Such campaigns require an upfront investment in public education, followed by tireless effort and patience, but they help to achieve both improved health outcomes and lower health costs in the long term, Zoughbie explains.

“Health insurance companies save money when people are healthy,” he says. “Local public health clinics save scarce resources when people are not coming in with preventable illnesses. Families are happier when grandma can take care of the kids and spend time with them, and she’s not losing her eyesight because of diabetes complications. It’s just one of these win-win-win no-brainers.”

A few participants in Microclinic’s nine-month program were severely obese, and Fiegl-Ding notes that some of those persons lost over 50 pounds and kept the weight off. He contrasts Microclinic’s approach to weight loss with several fad diets he studied while working and studying at the T.H. Chan School of Public Health at Harvard University.

“This program does not require some expensive meal plan that you have to buy,” he says. “It’s not for-profit in any way – this is a low-cost, community-based program.”

“One of the amazing things about Bell County is that once this program got going, we sort of saw a cascade of other things happen that were led by the community,” Zoughbie says. As the Microclinic gained momentum, participants started a community garden, he notes. Corner stores also changed their supplies to stock more healthy foods, and walking trails were installed. “The community as a whole was much more excited about changing what they eat and exercising more,” he says.

Ultimately, the Microclinic program became sustained by community members in Bell County long after classes officially ended – which is the organization’s goal. This mirrored results from more than 1,500 Microclinics worldwide. It’s a model that both Zoughbie and Fiegl-Ding hope will continue to catch on in other areas in the U.S. plagued with chronic diseases such as Type 2 diabetes.

“We want to show that basically for every $100, you can actually save $1,000 on treatment,” Fiegl-Ding says. “And we know this – we know that prevention is much cheaper than all of the insulin, the bariatric surgeries, the kidney dialysis. We want to show that community health programs like this are actually relatively low-cost. And if you invest more in the community, that further reinforces community health welfare, that will actually pay for itself.”

Program Details

Kentucky Health

About Kentucky Health

Learn how to improve your health through education and increased awareness. Dr. Wayne Tuckson, a colorectal surgeon in Louisville, hosts.

TV Schedules

Jump to Recent Airdates

Upcoming

Healthcare Networks: When Hospitals and Physicians Are on the Same Page - S15 E20

Dr. Tuckson speaks with Dr. Jody Prather, chief strategy and marketing officer at Baptist Health.

  • Sunday September 20, 2020 12:30 pm ET on KET
  • Sunday September 20, 2020 11:30 am CT on KET
  • Sunday September 20, 2020 5:30 pm ET on KETKY
  • Sunday September 20, 2020 4:30 pm CT on KETKY
  • Monday September 21, 2020 2:00 pm ET on KET2
  • Monday September 21, 2020 1:00 pm CT on KET2
  • Friday September 25, 2020 1:30 pm ET on KETKY
  • Friday September 25, 2020 12:30 pm CT on KETKY
  • Friday September 25, 2020 6:00 pm ET on KET
  • Friday September 25, 2020 5:00 pm CT on KET
  • Friday September 25, 2020 11:30 pm ET on KET
  • Friday September 25, 2020 10:30 pm CT on KET
  • Sunday September 27, 2020 12:30 am ET on KETKY
  • Saturday September 26, 2020 11:30 pm CT on KETKY
  • Sunday September 27, 2020 7:00 am ET on KET2
  • Sunday September 27, 2020 6:00 am CT on KET2
  • Sunday September 27, 2020 9:00 am ET on KETKY
  • Sunday September 27, 2020 8:00 am CT on KETKY

Intestinal Microbiome: Care and Feeding for Your Health - S15 E21

Dr. Tuckson speaks with Sara Police, Ph.D., assistant professor and associate director of graduate studies, Pharmacology and Nutritional Sciences at the University of Kentucky College of Medicine; and Jessica Houlihan, MPH, MSPAS, PA-C, microbiome and culinary medicine strategies in the Pediatric High BMI Clinic at UK Healthcare.

  • Sunday September 27, 2020 12:30 pm ET on KET
  • Sunday September 27, 2020 11:30 am CT on KET
  • Sunday September 27, 2020 5:30 pm ET on KETKY
  • Sunday September 27, 2020 4:30 pm CT on KETKY
  • Monday September 28, 2020 2:00 pm ET on KET2
  • Monday September 28, 2020 1:00 pm CT on KET2
  • Friday October 2, 2020 1:30 pm ET on KETKY
  • Friday October 2, 2020 12:30 pm CT on KETKY
  • Friday October 2, 2020 6:00 pm ET on KET
  • Friday October 2, 2020 5:00 pm CT on KET
  • Friday October 2, 2020 11:30 pm ET on KET
  • Friday October 2, 2020 10:30 pm CT on KET
  • Sunday October 4, 2020 12:30 am ET on KETKY
  • Saturday October 3, 2020 11:30 pm CT on KETKY
  • Sunday October 4, 2020 7:00 am ET on KET2
  • Sunday October 4, 2020 6:00 am CT on KET2
  • Sunday October 4, 2020 9:00 am ET on KETKY
  • Sunday October 4, 2020 8:00 am CT on KETKY

Preventive Cardiology: Can We Prevent Cardiac Deaths?

Dr. Tuckson speaks with cardiologist Dr. Henry Sadlo.

  • Sunday October 4, 2020 12:30 pm ET on KET
  • Sunday October 4, 2020 11:30 am CT on KET
  • Sunday October 4, 2020 5:30 pm ET on KETKY
  • Sunday October 4, 2020 4:30 pm CT on KETKY
  • Monday October 5, 2020 2:00 pm ET on KET2
  • Monday October 5, 2020 1:00 pm CT on KET2
  • Friday October 9, 2020 1:30 pm ET on KETKY
  • Friday October 9, 2020 12:30 pm CT on KETKY
  • Friday October 9, 2020 6:00 pm ET on KET
  • Friday October 9, 2020 5:00 pm CT on KET
  • Friday October 9, 2020 11:30 pm ET on KET
  • Friday October 9, 2020 10:30 pm CT on KET
  • Sunday October 11, 2020 12:30 am ET on KETKY
  • Saturday October 10, 2020 11:30 pm CT on KETKY
  • Sunday October 11, 2020 7:00 am ET on KET2
  • Sunday October 11, 2020 6:00 am CT on KET2
  • Sunday October 11, 2020 9:00 am ET on KETKY
  • Sunday October 11, 2020 8:00 am CT on KETKY

Interventional Cardiology: Micro Techniques, Macro Results

Dr. Tuckson's guest is cardiologist Dr. Amir Piracha.

  • Sunday October 11, 2020 12:30 pm ET on KET
  • Sunday October 11, 2020 11:30 am CT on KET
  • Sunday October 11, 2020 5:30 pm ET on KETKY
  • Sunday October 11, 2020 4:30 pm CT on KETKY
  • Monday October 12, 2020 2:00 pm ET on KET2
  • Monday October 12, 2020 1:00 pm CT on KET2
  • Friday October 16, 2020 1:30 pm ET on KETKY
  • Friday October 16, 2020 12:30 pm CT on KETKY
  • Friday October 16, 2020 6:00 pm ET on KET
  • Friday October 16, 2020 5:00 pm CT on KET
  • Friday October 16, 2020 11:30 pm ET on KET
  • Friday October 16, 2020 10:30 pm CT on KET
  • Sunday October 18, 2020 12:30 am ET on KETKY
  • Saturday October 17, 2020 11:30 pm CT on KETKY
  • Sunday October 18, 2020 7:00 am ET on KET2
  • Sunday October 18, 2020 6:00 am CT on KET2
  • Sunday October 18, 2020 9:00 am ET on KETKY
  • Sunday October 18, 2020 8:00 am CT on KETKY

Gun Violence: It Is a Public Health Issue

Dr. Tuckson speaks with surgeon and critical care specialist Dr. Keith Miller.

  • Sunday October 18, 2020 12:30 pm ET on KET
  • Sunday October 18, 2020 11:30 am CT on KET
  • Sunday October 18, 2020 5:30 pm ET on KETKY
  • Sunday October 18, 2020 4:30 pm CT on KETKY
  • Monday October 19, 2020 2:00 pm ET on KET2
  • Monday October 19, 2020 1:00 pm CT on KET2
Jump to Upcoming Airdates

Recent

Diabetes: It's More Than Just Sugar - S15 E19

  • Sunday September 20, 2020 9:00 am ET on KETKY
  • Sunday September 20, 2020 8:00 am CT on KETKY
  • Sunday September 20, 2020 7:00 am ET on KET2
  • Sunday September 20, 2020 6:00 am CT on KET2
  • Sunday September 20, 2020 12:30 am ET on KETKY
  • Saturday September 19, 2020 11:30 pm CT on KETKY
  • Friday September 18, 2020 11:30 pm ET on KET
  • Friday September 18, 2020 10:30 pm CT on KET
  • Friday September 18, 2020 6:00 pm ET on KET
  • Friday September 18, 2020 5:00 pm CT on KET
  • Friday September 18, 2020 1:30 pm ET on KETKY
  • Friday September 18, 2020 12:30 pm CT on KETKY
  • Monday September 14, 2020 2:00 pm ET on KET2
  • Monday September 14, 2020 1:00 pm CT on KET2
  • Sunday September 13, 2020 5:30 pm ET on KETKY
  • Sunday September 13, 2020 4:30 pm CT on KETKY
  • Sunday September 13, 2020 12:30 pm ET on KET
  • Sunday September 13, 2020 11:30 am CT on KET

Filling Prescriptions: Why Can't I Just Buy Online? - S15 E18

  • Sunday September 13, 2020 9:00 am ET on KETKY
  • Sunday September 13, 2020 8:00 am CT on KETKY
  • Sunday September 13, 2020 7:00 am ET on KET2
  • Sunday September 13, 2020 6:00 am CT on KET2
  • Sunday September 13, 2020 12:30 am ET on KETKY
  • Saturday September 12, 2020 11:30 pm CT on KETKY
  • Friday September 11, 2020 11:30 pm ET on KET
  • Friday September 11, 2020 10:30 pm CT on KET
  • Friday September 11, 2020 6:00 pm ET on KET
  • Friday September 11, 2020 5:00 pm CT on KET
  • Friday September 11, 2020 1:30 pm ET on KETKY
  • Friday September 11, 2020 12:30 pm CT on KETKY
  • Monday September 7, 2020 2:00 pm ET on KET2
  • Monday September 7, 2020 1:00 pm CT on KET2
  • Sunday September 6, 2020 5:30 pm ET on KETKY
  • Sunday September 6, 2020 4:30 pm CT on KETKY

Taking Care of Patients with Intellectual and Developmental Disabilities - S15 E17

  • Sunday September 6, 2020 9:00 am ET on KETKY
  • Sunday September 6, 2020 8:00 am CT on KETKY
  • Sunday September 6, 2020 12:30 am ET on KETKY
  • Saturday September 5, 2020 11:30 pm CT on KETKY
  • Friday September 4, 2020 6:00 pm ET on KET
  • Friday September 4, 2020 5:00 pm CT on KET
  • Friday September 4, 2020 1:30 pm ET on KETKY
  • Friday September 4, 2020 12:30 pm CT on KETKY
  • Monday August 31, 2020 2:00 pm ET on KET2
  • Monday August 31, 2020 1:00 pm CT on KET2
  • Sunday August 30, 2020 5:30 pm ET on KETKY
  • Sunday August 30, 2020 4:30 pm CT on KETKY

Rural Health Care Practices: It's More Than Just a Doc-in-a-Box - S15 E16

  • Sunday August 30, 2020 9:00 am ET on KETKY
  • Sunday August 30, 2020 8:00 am CT on KETKY
  • Sunday August 30, 2020 12:30 am ET on KETKY
  • Saturday August 29, 2020 11:30 pm CT on KETKY
  • Friday August 28, 2020 11:30 pm ET on KET
  • Friday August 28, 2020 10:30 pm CT on KET
  • Friday August 28, 2020 6:00 pm ET on KET
  • Friday August 28, 2020 5:00 pm CT on KET
  • Friday August 28, 2020 1:30 pm ET on KETKY
  • Friday August 28, 2020 12:30 pm CT on KETKY
  • Monday August 24, 2020 2:00 pm ET on KET2
  • Monday August 24, 2020 1:00 pm CT on KET2
  • Sunday August 23, 2020 5:30 pm ET on KETKY
  • Sunday August 23, 2020 4:30 pm CT on KETKY
  • Sunday August 23, 2020 12:30 pm ET on KET
  • Sunday August 23, 2020 11:30 am CT on KET

Pediatric Anesthesia: Making Surgery Easier for Kids and Docs - S15 E15

  • Sunday August 23, 2020 9:00 am ET on KETKY
  • Sunday August 23, 2020 8:00 am CT on KETKY
  • Sunday August 23, 2020 7:00 am ET on KET2
  • Sunday August 23, 2020 6:00 am CT on KET2
  • Sunday August 23, 2020 12:30 am ET on KETKY
  • Saturday August 22, 2020 11:30 pm CT on KETKY
  • Friday August 21, 2020 6:00 pm ET on KET
  • Friday August 21, 2020 5:00 pm CT on KET
  • Friday August 21, 2020 1:30 pm ET on KETKY
  • Friday August 21, 2020 12:30 pm CT on KETKY
Top

Season 15

Catching My Breath: Lung Diseases and Their Causes

S15 E24 Length 27:25 Premiere Date 5.24.20

Pain Management and Treatment of Addiction

S15 E23 Length 26:55 Premiere Date 5.17.20

Intestinal Microbiome: Care and Feeding for Your Health

S15 E21 Length 25:51 Premiere Date 5.3.20

Health Care Networks

S15 E20 Length 27:11 Premiere Date 3.29.20

Diabetes: It's More Than Just Sugar

S15 E19 Length 26:56 Premiere Date 3.22.20

Filling Prescriptions: Why Can't I Just Buy Online?

S15 E18 Length 26:46 Premiere Date 3.15.20

Caring for Patients with Developmental Disabilities

S15 E17 Length 27:03 Premiere Date 2.23.20

Rural Health Care Practices: Serving a Region In Need

S15 E16 Length 28:46 Premiere Date 2.15.20

Pediatric Anesthesia: Making Surgery Easier for Kids

S15 E15 Length 26:54 Premiere Date 2.9.20

Rehabilitation: Getting Back to the New Normal

S15 E14 Length 27:26 Premiere Date 2.2.20

Microclinic: Simple Solutions for Complex Problems, Part 2

S15 E13 Length 27:35 Premiere Date 1.26.20

Microclinic: Simple Solutions for Complex Problems, Part 1

S15 E12 Length 27:26 Premiere Date 1.19.20

Changing Curriculum to Meet Unique Patient Needs

S15 E11 Length 27:14 Premiere Date 1.12.20

Colon Cancer: Can We Prevent Unnecessary Deaths?

S15 E10 Length 26:56 Premiere Date 1.5.20

Infections and Other Urinary Tract Problems

S15 E9 Length 27:02 Premiere Date 12.15.19

Health Insurance for All: What Does It Mean?

S15 E8 Length 27:50 Premiere Date 11.24.19

Huntington's Disease

S15 E7 Length 28:42 Premiere Date 11.17.19

Natural Approaches to Health and Nutrition

S15 E6 Length 26:52 Premiere Date 11.10.19

Vaping, E-Cigarettes and Kids: Not a Good Mix

S15 E5 Length 27:37 Premiere Date 11.3.19

Breast Cancer: Determining Your Risk

S15 E4 Length 27:36 Premiere Date 10.27.19

Cystic Fibrosis: Improvements in Outcomes

S15 E3 Length 26:53 Premiere Date 10.20.19

Rhinoplasty: Looking Good, Breathing Better

S15 E2 Length 27:42 Premiere Date 10.13.19

Child Psychiatry

S15 E1 Length 27:15 Premiere Date 10.6.19

Explore KET