Editor’s Note: This post is part of an ongoing series written for Health Affairs Blog by local leaders from communities honored with the annual Robert Wood Johnson Foundation Culture of Health Prize. In 2014, six winning communities were selected by RWJF from more than 250 applicants and celebrated for placing a priority on health and creating powerful partnerships to drive change.

A small Appalachian coal mining town might seem like an unlikely place for a contemporary community health revolution, but Williamson, WV can proudly claim that achievement. As a city of 3,098 people along the banks of the Tug Fork River, Williamson has a long history of defying expectations. In the late 19th and early 20th century, it became the center of a cultural renaissance that began when the Norfolk and Western Railway brought people from all over the United States to Mingo County (Williamson is the county seat).

This diverse group of entrepreneurs and miners turned Williamson into a sophisticated urban center that became the “heart” of America’s billion-dollar-coal-field. They created an infrastructure that survived three great floods and today is part of a network of facilities that are being used for renewed development through the Sustainable Williamson project — a six-part initiative designed to bring better health and economic opportunity to a region faced with daunting financial and public health challenges.

An Emerging Health Crisis

The coal industry’s shifting fortunes and other factors translated into significant job losses in Williamson and Mingo County. By 2009, the unemployment rate was 9.7 percent and climbing. Nearly 30 percent of Mingo County’s 26,000 residents were living in poverty. Life expectancy was at 67.7 years, one of the lowest rates in West Virginia.

With poverty came poor health. A 2008 to 2009 survey, conducted by West Virginia University researchers, found one in three Mingo County fifth graders had hypertension. Among low-income children, 19.9 percent were obese. The rate was 37 percent for adults.

Chronic illnesses threatened to overtake the community. Among Mingo County adults, 12.5 percent had diabetes, 15.7 percent had cardiovascular disease, 45.9 had hypertension, and 47.6 percent had high cholesterol.

Coming Together to Meet a Need

At the same time, a handful of people who had grown up in Williamson were separately struggling to help their neighbors, but not succeeding. Vicki Lynn Hatfield, a nurse practitioner wanted to provide better care for people with diabetes. Bill Richardson, a West Virginia University Extension agent was exploring ways to increase access to healthy food.

At my primary care practice, I became increasingly concerned about the growing number of patients who could not afford care. Armed with 2009 health data, this small group of people formed the team that would lead Sustainable Williamson. With no funding, but plenty of passion and commitment, the group marshaled every available resource to get Williamson, Mingo County, and the surrounding area back on its feet. Together, we launched what the local paper called “a healthy conspiracy.”

Increasing Access to Care

To provide primary care, dental, and mental health services, we started a free clinic in April 2011 at my primary care practice. In December of that year, we received an $80,000 planning grant from the Health Resources and Services Administration (HRSA). The need for care was so great, that the free clinic became the Williamson Health and Wellness Center, a federally qualified health center, in October of 2013. That year, HRSA awarded the center $650,000 to support clinic operations. In the last six months, the center has seen 1,300 patients. It is the umbrella organization for the management of the Sustainable Williamson initiative.

Hatfield’s project became the Mingo Diabetes Coalition, a part of Sustainable Williamson and partner in the Southeastern Diabetes Initiative (SEDI), funded by the Centers for Medicare and Medicaid Services. The coalition offers diabetes screening, nutrition and fitness counseling, health literacy training, transportation, and services to address depression or substance abuse.

The Coalition’s Diabetic Education Center has seen a 2.2 percent drop in hemoglobin A1C levels for more than 400 patients. The A1C test measures average blood glucose levels over three months to determine how well a person’s diabetes treatment plan is working. The ideal level is below 7 percent, a person with uncontrolled diabetes might have an A1C as high as 8 percent. A 2 percent drop is significant and difficult to achieve. Preliminary data from the SEDI portion of the program has also shown a 2.2 percent A1C level reduction.

To make exercise not only fun, but accessible, Sustainable Williamson also initiated a lunchtime walking program that became so popular several teams virtually “walked” to California. The local Road Runners’ Club also holds monthly 5K runs that began with 23 participants and now have more than 400 for each run. Twitter and Facebook are used to publicize fitness activities. Participants enjoy posting “healthy selfies” and sharing their fitness journey.

Growing Better Health

Linked to the effort to address diabetes, heart disease, and obesity was the need to increase access to healthy food. Mingo has one grocery store that is a 30-minute drive for most people; more than 12 percent of residents are without cars.

The solution was the Williamson Farmers Market and community garden. The project includes: two high tunnels (greenhouses) to grow produce year-round; 42 raised beds that include plots near public housing and a mobile market. There is also an orchard on reclaimed, strip-mined land, and a wellness coach who promotes good nutrition and exercise in schools.

In addition to boosting the area’s economy—farmers market members shared a $75,000 profit in 2013, up from $20,000 in year one—locally grown produce is fresher and more nutritious.

Healing the Local Economy

Sustainable Williamson is also working to advance the area’s economic development through several projects. At the annual Health Innovation Hub event, entrepreneurs present new ideas and receive expert advice. Caterer Debbie Young has just opened her business, a downtown eatery specializing in healthy food. The Coalfield Development Corporation trains and hires local workers to build affordable housing, with a focus on reclaimed materials and energy efficient construction. Gilliam Solar, LLC trains workers to install solar panels such as those that power the center.

Capitalizing on Williamson’s history as home of the legendary Hatfield and McCoy feud, entrepreneur Adam Warren created Hatfield & McCoy Guided Tours.

Learning to Transform Culture

Williamson made such rapid progress because professionals, community members, and residents came together to work toward a common goal. But there are also other factors that are critical to ongoing success:

  1. Boots on the ground. The diabetes coalition has shown the most dramatic, measurable change in the health status of residents due, largely, to its weekly health worker home visitation program. In one instance, a health worker discovered that a well-meaning patient was attempting to give herself insulin without removing the cap of her insulin pen, a problem resolved with training.
  2. Connection and collaboration. Every Sustainable Williamson activity is connected to the other. Projects are cross-promoted, cross-supported, and linked. Once residents participate in one program, they learn about other available resources, through printed materials, social media, and word of mouth.

Whether it’s a pair of strong hands that help raise a building, a farmer’s wisdom on how to sow a winning crop, or a health care provider’s willingness to embrace a new way of giving care, Williamson is a shining example of how a culture of health can grow and thrive when a community commits to change.

Data on the progress of Sustainable Williamson is being gathered by project leadership to identify successes and ongoing challenges and chart the course for the next phases of the initiative.