Inspiring Health at the Community Level - Esther Dyson, Executive Founder of Wellville

SHIV GAGLANI: Hi, I'm Shiv Gaglani, co-founder of Osmosis. Today, I'm delighted to welcome Esther Dyson to Raise the Line. Esther has decades of experience as an advisor to and investor in companies in a wide range of sectors, from education, to healthcare, to information technology. A few examples include 23andMe, Omada Health, and Banfield. She's also the executive founder of Wellville, a ten-year nonprofit project dedicated to demonstrating the value of long-term investment in health inequity, with a focus on childhood development, diabetes, and mental health support. 

Currently, Wellville is working in five small communities throughout the U.S., including Muskegon, Michigan, and Spartanburg, South Carolina. Esther has a strong interest in space and is the first guest on this podcast to have earned a certificate of completion from the Yuri Gagarin Cosmonaut Training Center. Before we get started, I'd also like to thank Alan Patricof and Peter Frishauf, who are advisors to Osmosis, for the introduction to Esther, as well as Esther herself for introducing us to Ann Wojcicki at 23andMe, with whom we recently did a direct-to-consumer genetics education course. So Esther, thanks so much for taking the time to be with us today.

ESTHER DYSON: It's a pleasure. 

GAGLANI: I'd like to first start by learning a bit more about you. What was your early career like, and how did you wind up getting involved with investing in and advising companies?

DYSON: I'm pretty old, so I've had a long career. My parents were both scientists, a mathematician, and a physicist. So I was always curious about things and worked for my high school newspaper, and then my college paper, and ultimately, became a fact checker and reporter for Forbes Magazine. So my superpower is asking questions, and that's pretty good training for just about anything. 

While I was at Forbes, I got interested in tech, and ultimately moved to Wall Street for five years, where I followed some tech companies, including Cray Research, which was one of the very first supercomputers, and also, somewhat randomly, a little startup called Federal Express. I've also had an abiding interest in logistics. Then I joined this guy who had a technology newsletter called the Rosen research letter, or something like that, and then for 25 years, I ran the newsletter, and its annual conference, and was the court jester on the scene, watching the development. Our speakers included Bill Gates, and Steve Jobs, and later on, Reid Hoffman, and this guy Mark Zuckerberg. I watched the whole thing emerge, and ultimately, sold it, and became an angel investor trained as a cosmonaut, then began to get interested in healthcare, and ask the fundamental question you've got to ask if you look at healthcare: Why do we spend so much money and effort fixing things that shouldn't have been broken in the first place? 

I thought, “Somebody should just do a health XPRIZE.” I was going to give a talk saying that, and realized that would be a terrible talk. So I decided to announce that I was going to run what would initially we thought of as a contest, for five communities—not five healthcare outfits, but actually the people in five communities—to make the greatest improvement in their communities over five years with five metrics. 

One of the privileges of starting something yourself—and I ended up funding it myself, too—is just like with a startup, you get to pivot. So it ended up being a ten-year project. I hired a CEO because I've seen so many founders destroy the things they love when there's nobody there to tell them, “Hey, dude. Listen. Make sense.” So I have this wonderful partnership with our CEO, Rick Brush, and we are now in year six of the ten-year project that ends in 2024.

GAGLANI: You've preempted my question a bit, which is great, because obviously a lot of our audience are currently, or will soon be, practicing in the healthcare field. What exactly is Wellville, and what are some of the projects within Wellville that you are working on? Is it the same sort of initiatives across all five communities? How did you pick those communities; how are you differentiating them, etc.?  

DYSON: It is most definitely not “a nice lady from New York is here to fix you with her programs and her technology.” We're basically a coaching organization. There's only seven of us. Five of us each has one of the communities where we—at least until recently—show up once a month. Like a coach, we don't play the game. We coach the people who do, and they own it. So metaphorically, we're not giving them fish; we're not teaching them how to fish. We're helping them to build their own fishing schools. That kind of long-term change, where you're actually improving people's lives from the start—ideally, working with kids—takes a long time, which is why ten years is necessary rather than a luxury. 

Each community is different. They're all under 200,000 people. The whole idea when we started back in 2013, 2014, we put out a call for applications. You had to be under 200,000 people. You had to have some kind of cross-sector collaborative, and you had to have a community that was a discreet community. People lived there, worked there. They weren't commuting in and out, and they sort of felt this was their home. So you could address the community, rather than, for example, a population of people with a certain kind of cancer, or some subset. We were looking not just for diversity within the communities, but diversity across the community. So it wasn't the best five, but the best group of five from which you can learn, in a sense. 

To our amazement, we got 42 communities that applied. So in the summer of 2014, Rick Brush and I spent most of it visiting ten of the communities, and ultimately picked five. So that's how it all started, and of course, we thought we'd have these five metrics, and everything would be orderly, and of course, it wasn't like that at all. It's much more like raising children than building a barn. We just got to work, trying to be useful. 

We've learned, as you can imagine, a whole lot. Our goal ultimately is to help the communities with their goal, which is to become healthier and more equitable places, but also, not to scale by doing more communities, but to scale by inspiring other communities to do the same thing. We applied to the MacArthur Foundation for one of their amazing grants, and of course, didn't get it, but it was a useful process. One question they asked was, “Why are you so special? What are your backgrounds?” The usual, “We want the bios.” In a sense, the better we are, the less valid our mission is, because our fundamental premise is, “You can do it for yourselves. You don't need a bunch of outsiders. You can develop your own community affordances. You can have your own parents connect better through the schools. This has to be done by the community; it can't be done by a bunch of benevolent outsiders who show up for two years and then leave. 

As you can imagine, a lot of people in the communities were very skeptical: “Yeah, we've had people come in before, and tell us what to do, and they paid us to do it, and then when they left, it was over.” So we're trying to help them build this for themselves, and that's tremendously satisfying and not a very quick thing to do, but we're beginning to see these different institutions emerge. We're beginning to see people think more ambitiously and more accountably. I was just in Muskegon, and I can tell you a little more about that. It's not easy, but people want things to be better, and if you help them believe in themselves, they can be. 

GAGLANI: Yes. So going to some specific examples, right before we started this podcast, you were talking about some of the work in Muskegon helping underprivileged teens, educating them about their health by getting them involved measuring their own glucose with continuous glucose monitors. Can you tell us a bit more about that, as one example? How did it start? How are you going to measure success? Anything else you want to share about that initiative?

DYSON: I will do that with pleasure, but I have to put a whole lot of caveats on the beginning. The reason I'm thinking about it so much is that I'm in the middle of editing our study proposal for what amounts to a non-clinical trial that we're presenting to Abbott this week or next, asking for glucose monitors for probably on the order of forty to fifty kids. 

Diabetes is a huge problem in our communities, as it is across the country, and I kept on thinking, what I'd love to do is give every second grader a continuous glucose monitor because second graders are really curious. They'd love to see this stuff. It's just so much more interesting than some kind of textbook, and second graders don't actually learn about blood glucose anyway. That was just one of my crazy ideas, which as I mentioned, is why we have a CEO who is a little more sensible. 

But then I was at the Boys and Girls Club in Muskegon, and I saw one room where the kids were making presentations to one another, another they were drawing and doing art. Those are both great, and then in the third room, they were watching a video and falling asleep, and the video was a science video. That continuous glucose monitor idea came up again, and I thought, “Hmm.” Long story short, I talked to somebody at Abbott, who said, “Oh, no, we can't support off-label use.” Then the guy who does their studies said, “Well, actually, we can, because on-label use, it's no longer a study; it's just sales. But off-label use, that's what we want to learn about.” 

The basic idea is to give the kids four weeks. The glucose monitors last two weeks, so four weeks, two glucose monitors apiece, and of course spares in case something goes wrong, and so forth and so on. We've assembled a bunch of people in Muskegon who will actually do this. It's hosted at the Boys & Girls Club. There's a local doctor called Dr. Wallace, who will lead the course and do the curriculum. She's very much a public health, healthy living as opposed to, “I'm just going to fill you up with medicines,” loves children, and is actually now in an academic position at the Stryker School of Medicine. She'll be the principal investigator and be leading this year-long course. After the four weeks, they continue to learn in a group setting with Dr. Wallace and various other people coming in, not just about your blood glucose, but about how your body reacts to stress, as well as food. How your metabolism works, your physiology overall, how you differ from other kids—not everybody reacts the same to rice, or bananas, or smoked salmon, or whatever. Also learning about how to read a food label, how to compare two grams of protein versus five grams of fat, and eight grams of protein versus 20 grams of fat, or whatever it is. 

But what makes this so much more interesting is that it's not stuff out of a book that feels irrelevant, but rather, you get to be one of the kids in this really interesting class with a special device which most kids don't have, and these generally are not the kids that usually get that privilege. So it's designed to make them feel important and special, not extraordinary, but just like, you know, “Hey, you matter,” and to learn about themselves, to learn about how the food system works, how the profit motive makes companies market stuff to them that may not be good for them. Then in June, they get another two-week stretch with the continuous glucose monitor and see if their eating behaviors, or their blood sugar has changed, but we also want to see what they've learned, where we'll be asking what impact it's had on their family, and how their family eats together, and so forth and so on. Frankly, my hope is ten years from now, some kid will come up to me and say, “Hey, I'm a med student, and I was in that course, and this changed my life.”

This is not what we're doing in every community; it just kind of emerged because Boys and Girls Club is there, and Dr. Wallace, and all these other things, but it's the kind of thing that I think, “Hey, this is how education should work.” It's people who are curious and who learn from the reality around them, not just from the books, and who get help in understanding how the world actually works, which gives them a sense of agency, and who knows what happens next. 

GAGLANI: I love that for a number of reasons, especially now because of all the issues we're seeing in our day-to-day lives around people not understanding and not having a good sense of health literacy. Everyone who goes through this doesn't have to become a doctor or a scientist, but if they have a better understanding of health literacy, and why they should take vaccines, or what a low-carb diet is or low-fat, how they differ, these things can really add up and make it so that we don't need to raise the line as much and have as many healthcare professionals. 

DYSON: With most of this health advice, you don't see the immediate impact. Your blood glucose doesn't go up in two minutes, but half an hour later, you can see the impact of what you ate, or, you know, I tripped and broke my ankle recently, and my blood sugar level was considerably higher because of all the stress. You can see that, and it just makes it more real. But again, caveat: we still haven't gotten the approval from Abbott. So maybe by the time this podcast comes out, you can add an epilogue or something, but that is our plan. 

GAGLANI: Awesome. Well, what advice would you give to students right now or any young person considering a career in healthcare given that so many of our audience are either in medical or nursing school or considering careers in that?

DYSON: It would be: bless you, study hard, and remember who you're doing this for—which is in a sense, yourself, because it will give you a sense of purpose that will make your life matter, both to you and the people around you. It's hard, but it's worthwhile. People who are happy aren't happy because they're sitting around being happy. They're happy because they overcame challenges and accomplish things. As a medical professional, that's what you'll be doing.

GAGLANI: That's great advice, especially because right now we're seeing so much churn and burnout, you know, at least in the US healthcare workforce because of the COVID resurgence we're seeing.

DYSON: It's worldwide. 

GAGLANI: Yes, worldwide, global shortages and burnout is definitely a global phenomenon. I know we're coming up on time, so I did want to make sure I had the time to ask you about your predictions around a post-COVID world—hopefully, a post-COVID world. Obviously, it's going to be endemic, but what are some of the core changes to the healthcare system, and even the communities that you work with at Wellville, that you think are going to be lasting well beyond any surges of the pandemic?

DYSON: The ravages of inequity, not just in healthcare, but in education, and economics, and everything. The impact of COVID has been so much worse on poor people, and on black people, and on all the people who are not lucky, versus those like me who are very lucky. I think that's becoming much more apparent, even to people who are pretty much blind to it. So my hope is that we start, not to be political, but to be policy-oriented. 

Some of the investments that Biden is trying to make, in not just physical infrastructure, but human infrastructure: in education, in training, in workforce development, in child support, child care. All these things are so important. They're an investment in our human infrastructure, and they pay off. It's not like we're spending money; we're investing money in making a much better world where rich people won't have to pay as much taxes, because people will be healthier and will be more productive. It's not just sinking money into a pit, it's investing money into keeping people healthy, and productive, and happy, and reducing levels of addiction, and crime, and poor health, and all the things that have made COVID even more difficult than it had to be. 

GAGLANI: Yes, that's a recurring theme that's come up with our guests. I'm thinking back to Christopher Chen of ChenMed, who shared some very sobering and interesting statistics about how not just life expectancy, but other measurable health and economic indicators vary so dramatically by zip code, especially because they serve a Medicaid population and underprivileged communities, sort of like the ones you've mentioned with Wellville. I know we're at time, but I did want to give you the opportunity to share anything that you wish I'd asked you that I haven't asked you that you'd like to be able to share with our audience at Raise the Line. 

DYSON: Yes, two things. I want to call out ProofPilot, which is another company I'm an investor in, that is doing the underlying data management, and study design, and administration for what we call the Muskegon Mets Junior Division. Second, this is slightly broader. Addiction is a disease of our country right now, and it's not just addiction to drugs, it's addiction to sugar, its addiction to short-term profits. It's even the addiction of many community organizations to short-term grants. It's this inability to think long-term, and it's caused so many of our problems. That's why Wellville is a ten-year project, and it's why I support investing long-term in the future, and not looking for immediate results. 

GAGLANI: Yes, I think it's really very important for us to be thinking much longer-term, because certainly there are a lot of things that, had we moved on them sooner, probably would have been more manageable—COVID being one of them, and obviously some of the stuff we're seeing with the climate being another. 

Esther, I really want to thank you for taking the time to be with us today, and more importantly, for the career you've dedicated to entrepreneurship, technology, and healthcare. The work that you're doing at Wellville was quite prescient given all the things that COVID has exacerbated just within the last eighteen months. 

DYSON: Thank you very much, but I'm having the most fun in my life, so thank you. 

GAGLANI: I'm really glad to hear that, and with that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show, and remember to do your part to flatten the curve and raise the line. We're all in this together. Take care.