The Missing Link: Sally St. John on the YMCA's Role in Preventing Chronic Disease

In this episode of Taking Healthcare by Storm, Quality Insights Medical Director Dr. Jean Storm speaks with Sally St. John, MA, NBC-HWC, a seasoned nonprofit senior leader, integrative health and wellness coach, and the Managing Director of Partnerships and Programs at Open Source Wellness. 

Sally discusses why chronic disease persists and how community connection and coaching can support whole-person health beyond the clinic. She highlights the YMCA’s history and reach, shares early Community as Medicine partnership wins, and calls for stronger reimbursement and infrastructure to better link healthcare with community-based programs.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

The views and opinions expressed by the host and guests are their own and do not necessarily reflect the views, positions, or policies of Quality Insights. Publication number QI-091826-GK

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Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

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Hi, everyone. Welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical director here at Quality Insights. Today, I'm excited to welcome Sally St. John, a nationally board-certified health and wellness coach and director of community as medicine implementation partnerships at Open Source Wellness. Sally has dedicated her career to helping people achieve whole-person health, something we should all strive for, by recognizing that our wellbeing is shaped not by just what happens in the doctor's office, but by the communities we belong to, the relationships we build, and the environments in which we live. Our conversation today centers around a fascinating white paper which I have read many times because I think this concept is fascinating and relevant currently. The title of the paper is What If the YMCA Is the Missing Link in America's Health System? It challenges us to rethink healthcare by asking a simple but powerful question: What if one of the most effective solutions to America's chronic disease epidemic has been hiding in plain sight all along? And I think it has been. We'll talk about why chronic disease continues to rise despite incredible advances in medicine, why community may be one of the most under-utilized prescriptions we have, the remarkable 175-year history of the YMCA, and how organizations like the Y could become essential partners in preventing disease rather than simply treating it. We'll also explore Sally's innovative community as medicine model. We're gonna talk about real-world success stories, and then we're gonna discuss what the future of healthcare could look like if we truly embraced whole-person wellbeing. Sally St. John, thank you so much for joining me today. Thank you for having me. I mentioned in the intro you've spent your career at the intersection of holistic health, community wellbeing, and health coaching. What first drew you to this work, and what experiences convinced you that healing happens just as much outside the walls of the doctor's office as it does inside the doctor's office? Yeah, I love this question because I feel like in many ways I had initiation into the health and wellbeing field because from a very young age, I was managing my own chronic conditions. And in the management of those chronic conditions from an early age, I just hit several stop gaps when I relied on traditional healthcare and the conventional system of healthcare to manage or even try to reverse these conditions. And it was so ironic because my mother actually was... she's retired now, but was a healthcare administrator. She worked in quality improvement, and so we had access to all of these great doctors. She understood the system. But so often when I would go to my primary care appointments, and then when I was coming of age and I started seeing OBGYNs, you know, I only got 15 minutes with each of those providers. And just when we were starting to get to know what was going on with my body, the appointment was over And I spent a lot of my life in my teens and in my 20s just trying to figure out, like, it's gotta be different, right? Like, I gotta have other resources. And so I ended up becoming one of those people that had, like, a pile of books on their nightstand about all topics health and wellness, from nutrition to mindfulness to environmentalism to gardening. And I really started to make that connection that so much of our health is happening outside of these clinical appointments and how ironic it was that, like, I wasn't hearing that message when I was interacting with my clinical providers. And so that was probably the first, moment I had of, like, there's something more here. So of course, I started to put those readings into practice, and I tried all these different health and wellness modalities. And I was starting to recognize that by, like, changing my diet or investigating my values and what the world really meant to me, or what are my relationships like? Are they kinda surface-y? Are they toxic? Are they additive to my values? All that good stuff. , I started to realize my health and wellbeing was starting to improve. And I also recognized that, like, it's kinda lonely to do on your own, so you really have to find your people,, to stay motivated 'cause behavior change is really hard. So I started seeking, you know, all these different community spaces, and they weren't happening inside the clinic. So I realized at that point that health is really a holistic journey, and that there is a connection between what the clinical appointments are doing for you and also probably an even bigger connection of what you're doing outside of those clinical appointments that impact your health and wellbeing Yeah. There, yeah, so much to say there. Go ahead. I'm sorry. There's so much to say, yeah. And so then that's when I... It was like the early aughts, and health coaching was emerging, and I was like, "Huh, what's this?" And,, I met with a health coach. I remember taking her out for coffee, and it was like, wow, this is the role that could really help folks make that connection from what they're hearing in a clinical appointment to actually starting to make some health behavior change, help them connect to resources, other people and even their inner world. And so, um, in the early aughts, I made the decision to become a health coach, and that was back when the profession was very much the Wild Wild West. And since then, I have been advocating for that profession as well as a stronger holistic health model that includes both community and clinical healthcare. Yeah. And I think that is what the future needs to look like if because I, I do think we're reaching a breaking point in healthcare. Mm-hmm. So I am excited to, to really get into this conversation and learn how we can apply it. When people talk about chronic disease, we often focus on diabetes, heart disease, obesity, medications. But if you had to identify the biggest underlying driver of chronic disease in America, what do you think it is, and why do you think our healthcare system struggles to address it? Yeah. Jean, this is such a great question because the leader, the, the change management leader in me is like, what is the root cause here? Like, why isn't this clicking yet? We all know chronic disease year over year just keeps increasing in stats, and that is not new news, in healthcare. But yet we can't seem to make this move of getting that stat to reduce year over year. So I think it's a lack of connection with each other, with our environment, and our inner world of what makes up who we each are individually. So what our values are and what our purpose. And really doing that, like, reflective work of what matters most to us in this, like, big, beautiful life that we get to live. And I think healthcare struggles to address this like this root knowing because it just wasn't fundamentally designed to see the whole person. And when I say whole person, I mean, like, mind, body, spirit, environment, and all the social factors that make someone human. And rather, you know, like healthcare has been designed to be a reductionist approach that, primarily sees pathogens, first before the whole person. And in many ways, that has greatly served the management of many diseases and conditions and especially emergency acute care. But we know that emergency care and sick care is not the whole picture to someone's full expression of health and wellbeing. Yeah. And I love this. You know, it, it makes complete sense that we look at the whole person, but for some reason we don't, and I, I think we're just stuck in old models and we- Mm-hmm just need it needs to, the old models need to go. Definitely. Yeah. I agree. And this is not an easy pivot. And I think that's why it's so crucial that we think wider around the ecosystem of health and wellbeing. And so for so long, I think we've been trying to figure out how to solve the healthcare system to better meet the whole person, but maybe there's aspects about the healthcare system that are working that we should celebrate, but there's a larger ecosystem that needs to be integrated so we can truly serve the whole person. I wanna get into the white paper. I really enjoyed it, and one of the strongest themes in the paper is that community itself is a form of medicine, like it's a prescription and I love calling it that. Can you explain why belonging and social connection and supportive relationships are so powerful when it comes to preventing and even reversing chronic disease, right? That's unheard of. Yeah. Yeah, I mean, if I go back to my original share of how I got into this work it became very clear to me that it's very difficult to heal in isolation. To truly heal, we need each other, , we need the wisdom of each other, we need the systems that surround us. And then it's also important to name that all those systems weren't designed with everyone in mind, and so, that can feel even more isolating. So acknowledging that, like, we truly need healers and helpers, , in our community is so important in understanding how people can even get started in either managing or reversing their chronic disease. And I think unfortunately, our healthcare system has been fundamentally designed from an individualism lens. So what I mean by that, it is, you know, we, we have these one-on-one appointments. We often are seeing the patient through their chief complaints or their diagnoses. And the conversation kind of ends there. And too often patients are hearing, like, "You know, you need to just change this or that, and you will start to reverse your chronic condition, or you will better manage and be able to live with this throughout your entire life." But then the conversation kind of just ends there. And unintentionally, it starts driving patients to more shame and more isolation, because we're just not simply acknowledging how difficult it is for the human experience to, like, make these health behavior changes. But I think when we can find a space where we feel like we can be ourselves, we're being seen as a human and not a diagnosis or a pathogen, we start to belong, and we start to feel a little bit more connected to others. We can start to, you know, contemplate on what are my values, what matters most to me, and then automatically the motivation starts to present itself, , that we can make these health behavior changes less daunting. So it becomes kind of a we thing to become well rather than just isolating it to a me thing. And I think that is so crucial in understanding the foundation of what it takes to either manage or reverse a chronic disease. Yeah. I love that. It's not a... It's a we thing. It's not a me thing. Yeah. Yeah. Great bumper sticker, right? Yes. And, and the, you know, when people think about the Y and this is how I thought about it, they think about it as a gym with a pool and, and maybe, you know, with a, with some racketball courts and basketball courts. Totally. Yep. But your paper tells a much richer story, so can you give us a brief history of the YMCA and, and its original mission of strengthening spirit, mind, and body, and how that mission has evolved over the past 175 years? Yeah. I would be happy to. I would have never imagined that I would have lived a life studying the mission of the YMCA, but back around 2017 I actually took an executive position with the YMCA. And my role was to implement new whole person wellbeing programming as well as inspire a more community and whole person wellbeing approach to the YMCA. And it was so ironic to me because when you read the mission statement of the Y's, it includes the statement, "Mind, body, and spirit for all." And so the YMCA was founded on this knowing that in order for people to be truly well, it takes this holistic approach of spirit, mind, and body. And actually, when you look at the YMCA logo, inside the Y, there is a triangle, and that was intentional by the, by the founders many years ago, and each side of that triangle actually re- represents spirit, mind, and body. So the Y was really founded in response to an unhealthy social condition that was arising around 175 years ago, where community members were saying, "We're building all these big cities in response to the Industrial Revolution, and this might start compromising our ability to be healthy and well." In many ways, this idea of healthy living and, self-development was a very new idea in that time. But these community leaders had the foresight that there needed to be a space, almost a third place for people to connect, to commune and to talk about some of the most, like, pressing issues of the time that were creating the social conditions of that time. And what came from that was that they started practicing health and wellbeing activities together, such as physical activity. You know, like basketball was founded at the You know, camp as we know it you know, youth going to their camp over summer is all created by the YMCA. Group exercise and the concept of we can move in group and together was created by the YMCA. And not only was it physical activity, but it was also this idea of we also need to have contemplative spaces where we practice our spiritual beliefs, and we talk about faith and the role that faith has. And in that space, we-- there's also this natural knowing that there needs to be a deeper purpose, and how do we give back? So volunteering and community response and community organizing were all things that, like, made up the YMCA, and it starts to paint this picture of like, this is whole person health and wellbeing coming through a very strong community model. I love that. It, like a, a space, you know, where we can bring our whole selves and improve our health. I mean, that's fantastic, right? That's heaven. It's... Totally. And that's why, like, in the white paper we were like, this has been under our nose all along. The Y was fundamentally founded in these spaces. And it's really about how do we position the Y to really be the call to action for us to better serve the whole person? Yeah. And the title of the white paper is very provocative I think. And that's What If the YMCA is the Missing Link in America's Health System? So can you just expound a little bit about how you, why you believe that the YMCA is uniquely positioned to help address our nation's chronic disease epidemic? And what role can it play that hospitals and physicians offices just cannot? Yeah, I love this question. And we intentionally chose that article so it was provocative to really get people to think about YMCA in a different way. I think any time, you have a legacy brand like the Y everyone has their connotation of what that means. And like you mentioned in the last question, so many people think of the Y as a gym that has a pool. There's swimming lessons happening. They have gym memberships. But the Y is so much more. And so in many ways, this is a, this is an exercise in remembering the roots of the YMCA and allowing that mission to continue to come to life. And the YMCA footprint, so, like, all the facilities and the programming that it reaches, makes it the largest health and wellness nonprofit in the country. So it really has become the third place where people come to live their life, to play together, to volunteer together, to respond to some of the most pressing community needs. So in a sense, they are in service to health, wellbeing, and belonging for all Americans. So therefore, I think it's really positioned to help, reverse and manage this chronic condition epidemic that's happening in our country. Because people are already enrolled into the community of the Ys. They're choosing to, live there and play there and connect with their community there. And so it's just naturally, well-positioned to carry out the responsibility of reversing these chronic condition stats in our country. You've worked with YMCA leaders and healthcare partners across the country implementing Community as Medicine. Is there a story or a few examples, success stories, that really illustrate the impact this model can have on people's physical health, mental health, or sense of belonging? Yes. We've only been working with the YMCAs for almost three years now, and we're already seeing lots of early success in how this can , impact people's health and wellbeing. One program I will highlight is coming out of San Diego. That YMCA has made a partnership with TrueCare, which is a federally qualified health center system that primarily serves the Hispanic population And in their partnership, they, have created a mobile clinic that pulls up to the YMCA parking lot, and that operates as a primary care clinic while the Community as Medicine program is going on. And what has occurred here is they are seeing increased rates in patients actually coming to their primary care appointments because they are expressing, "I'm not going to just talk to my doctor. I get to go be with my peers. I get to connect. I get to be at the Y and have some fun." And it's motivating them to actually come to their primary care appointments. We also have another great success story of folks who are having a hard time connecting with their community, because they had just moved there, and they weren't sure where to go to navigate to find peers and friends to connect with. And this Community as Medicine group was prescribed to them by their physician to say, "Hey, this might be a place for you to connect, to not feel so socially isolated." And because our program here is delivered both in English and Spanish, we're reaching a larger population, and it allows for more cultural celebration and connection. And more and more people are driving community just by showing up to program Another program that I would lift is out of the Twin Cities in Minnesota. Y of the North there made a partnership with a private, clinic called HerSelf Health, and this clinic i- is new. They're serving to reach women over 55 'cause all too often this becomes a very vulnerable population in women's health, and women don't have the resources just going to their conventional OBGYN. And so, they made a partnership and said, "Hey, we want a Community as Medicine program that is just for women over 55." And that took off wonderfully. Women reported that they finally feel connected. They were feeling so isolated in managing this stage of life. They had no idea other women felt this way. So many of them were just white-knuckling it and didn't know that there was a place to talk about menopause and, like, your third act of life and, you know, re-evaluating your values and your purpose of what you, what more you want out of life once you reach this stage. Another example, that is actually emerging, they haven't launched yet, but we're really excited about this design, YMCA of Central Maryland, so out in Baltimore, chose to bring on Community as Medicine as a program in partnership with their healthcare partners to really address, the stigma of mental health in the Black community in Baltimore. And so this particular Y did a great job of recruiting coaches straight from the community to deliver Community as Medicine to again make that connection that everyone can have access to mental health and start to reduce that stigma of mental health in this community. And then the last one I'll share is a really unique one. Pensacola in northwest Florida has made a partnership with an FQHC that is specializing in opioid recovery, and they recognize that once the patients completed their traditional opioid treatment, that transition back into everyday life is a tough one. And so now they're integrating the Community as Medicine program to support those recovered opioid patients in transitioning from traditional treatment to a more community-based intervention or support program. And so we're really looking forward to seeing how that is supportive infrastructure for those patients I love all of those examples. They are so diverse and really demonstrated how this Community as Medicine model can serve in so many different areas. So I really, I am inspired. I feel optimistic now about the healthcare system in this country, so thank you. Oh, yay. That's so good to hear. Yes. So if we are having this conversation five years from now, what would you hope has changed? What does the future of the YMCA and its relationship with healthcare systems look like if your vision becomes reality? Yeah. I love this question. I think, and we bring this up in the whitepaper, and there is an excellent quote from Penny George, a philanthropist I worked very closely with at the YMCA, that if we could make the YMCA an extension of the primary care appointment, that is the future of the Y. And I think that then says the Y is not in service to, it is now considered part of the larger health and wellbeing ecosystem. And it's also allowing healthcare and patients to be more centered in their journey because people are choosing to work on their health and wellbeing in YMCAs. And in a way, that's us as, you know, the creators of health and wellbeing programming, the administrators, the practitioners, the providers saying, "We see you. This is where you actually wanna work on your health and wellbeing." So, like, let's not make this so clunky. Let's have more, or stronger connective tissue between healthcare and community-based organizations like the YMCA so you're not having to navigate the siloed effect of these two systems. They are actually working together to create a more cohesive, integrated care, system for the patient in mind first and foremost. Great. And again, I appreciate, I, the, the influx of optimism that you've given me about the future 'cause I am a, I'm a huge fan of the YMCA. So if, you know, the YMCA could save healthcare, I would be, like, a huge, a huge fan. It's like the underdog, right? Yes. It is. It's so like the underdog, and I... Well, I will share here, too, like, in order to get there, there's, there's a lot of paradigm shifts, right? Like, in many ways, , for generations, the Y leaders have been told, "You don't belong in healthcare. You belong in those community spaces, and you do this." And vice versa, the Ys probably have said to healthcare, like, "You don't belong in community. You stay in that clinical space." And so many way- in many ways, this is a call to action to each set of these leaders to say, like, we'd be more in service to our patients and our community participants and our members if we were actually willing to understand each other a little bit more and say, we belong, but let's figure out which lanes we're really good at, so, the people we serve don't have to work so hard to access the resources they need to be well. Yeah. Yeah. So I, I end all the episodes with an iteration of this question, and I'm very excited to hear your answer. If you suddenly found yourself in charge of healthcare in the United States tomorrow, what's the very first change you would make to improve the health of Americans? Wow, this is such a goosebump question. Thank you for asking it. And I'm glad you asked it 'cause, you know, changing healthcare is no small thing. And there's days you do feel really defeated, and I think it's these big dreamy questions, that you're holding in your podcast that are so important to keep us going, and keep ha- you know, continue that creative discussion of like how do we keep e- evolving this system to a better place? And I don't know, I think there's a few things I would say. The first I would share is I think we really need to increase the reimbursement capabilities for more group-based and community-based health intervention programming. , Right now there is such a demand for these community-based organizations like the YMCA to deliver this programming, but the funding infrastructure continues to be the big pain point. And there tends to be a lot of like pointing of fingers of "Oh, the payer needs to solve this problem. Oh, the clin- you know, the healthcare system needs to solve this. No, the community-based organization needs to solve for this." And if we're working inside the current model or the current, you know, healthcare framework, I think one of the early ways for us to see more group care or community-based care come to life and actually start to drive positive health outcomes is to just get some stronger reimbursement in place, so we can see how these programs can come to life and serve the people who need it most. Another idea that I would love to see happen is that every primary care practitioner has a health coach alongside of them , because we know the reality of, the primary care provider is that they only have 15 minutes, and they get to... They, you know, they get down and dirty into the conversation of that appointment. But there's so much more there where we can better support the patient when they hear, "You know, you need to make some behavior changes. You need to exercise more. You need to eat healthier. You need to not be so isolated. You need to manage your stress." And a health coach could really be that bridge to helping someone reduce that shame, find empowerment, help guide them on what matters most to them in their health and wellbeing so they feel motivated to start to make those changes. And I think part... The last piece that I would bring in that I would, love to see big picture, and this idea is not mine. This I learned from the co-founder of Open Source Wellness, Dr. Elizabeth Markle, and it's that we design a health behavior change pharmacy infrastructure. So right now, we have pharmacy for all of the prescription drugs that we get prescribed in our, healthcare appointments, and that infrastructure is strong. It's robust. But we don't have a dedicated pharmacy to prescribe behavior change programs or, classes and group coaching and health education. We don't have a pharmacy to allow folks to go fill that prescription, and access that type of programming to make that behavior change. So a behavior health pharmacy would be such an add to the healthcare system, and ever since I heard Liz talk about that idea, I can't get it out of my mind. Because that would become the delivery system for health coaches to be more active in, conventional healthcare, and it would be a connector between community-based org- organizations and healthcare. I mean, th- this is amazing, and I really hope you get your wish. I love that idea of behavioral change pharmacy. You called it behavioral change pharmacy? Yeah. I love it. I, like, and I, I really hope... I mean, ideas are, you know, things are ideas first, right? So let's hope you get your wish. I sure hope so. It's such a good one, and we're actively trying to bring that to life with the Community as Medicine model inside The Y's. So if people want to learn more about you and what you're doing and maybe more about the white paper, how can they do that? Yes, so we have the white paper on our homepage at opensourcewellness.org. So you can easily go to that website and access the white paper. Feel free to reach out to me on LinkedIn Sally St. John, and feel free to email me at sally.stjohn@opensourcewellness.org. I would encourage anyone who's interested to reach out to Sally. Sally St. John, thank you so much for joining me today. I feel better that there are people like you in the world. So thank you so much for joining me w- in this conversation. Thank you for the rich discussion, Jean. This was great.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

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