Health Creation: Moving Beyond Disease Management

Thomas R. Frieden, MD, MPH American Journal of Public Health, 2010

In the United States, the allocation of healthrelated resources is the inverted, with greater attention and spending on the treatment of disease through healthcare services, rather than the promotion of health. (5) Our current healthcare system is oriented to emphasize disease management, which itself may
present a barrier for individuals to create health and embody wellbeing regardless of disease state. In fact, many Americans live in and have come to accept a state of unhealth.

While many efforts are underway to reform what is often referred to as a “broken” healthcare system, we must train our focus to the ways we can create health as well. (9)

Health Promotion International, Vol. 21 No. 2

The transactional nature of healthcare should be redefined as a salutogenic partnership between provider(s) and patient, with a primary focus on health creation. Partnering with a patient on their healthcare journey necessitates that the provider understands both the individual and the community in which they live. What would their lives look like if they were as healthy as they could imagine? What would their activities of daily living look like? What would their relationships look like? An individualized approach to care includes helping the individual to orient around what true health and healing looks like for them. This is best achieved when the healthcare encounter creates space for deep listening.

va.gov/WHOLEHEALTH/circle-of-health/index.asp

One innovative and highly collaborative approach to take advantage of a cross-sector team is the Whole Health Initiative, launched by the Veterans Health Administration.

In the VA’s Whole Health initiative, a team of professionals works with the patient to develop a personalized health plan focused around “what matters to you, not what is the matter with you.” (18) It is based on a Circle of Health concept that includes conventional medical as well as complementary and integrative approaches, partnering to address both prevention and treatment. (19)

An emphasis on whole person health is also unfolding in a new strategic vision within the National Center for Complementary and Integrative Health (NCCIH). This federal agency notes the importance of integrating knowledge across disciplines to improve the health of the whole person, and using a transdisciplinary approach to care that transcends traditional boundaries in medicine.

Efforts like these amplify the longstanding philosophy of integrative healthcare practitioners, and scale integrative approaches to health creation and disease management to truly transform our healthcare system.

Reimagine Healthcare Priorities

• Allocate greater public health resources to support health creation, particularly in communities of color
• Dedicate healthcare professional curricula to include competencies about salutogenesis, health creation, and collaborative integrative care
• Create opportunity for interprofessional education, to cross-train a range of healthcare disciplines around the central tenets of whole person health

Revise Healthcare Communication and Marketing

• Promote public health messaging that emphasizes patient empowerment, resilience, and wellbeing regardless of state of health or disease
• Emphasize movement, healthy foods, sleep, and stress management as foundational to good health at each healthcare encounter
• Engage a more comprehensive strategy of healthcare delivery, by including complementary and integrative practitioners in public and private health systems and insurance plans

Reorient Healthcare Systems to Prioritize Health Creation

• Use quality of life and wellbeing outcomes to measure system performance
• Reimburse any willing provider to deliver health coaching and lifestyle counseling
• Incentivize care coordination and cross sector engagement to decrease health disparities

A paradigm shift away from disease care and toward health creation presents providers and the communities they serve with an opportunity. Aligning resources around salutogenesis, emphasizing the fundamentals of health promotion, and enhancing crosssector collaboration can improve the public’s health and better meet the needs of communities who may have been previously disenfranchised by the healthcare system. Northwestern Health Sciences University is a committed partner in health creation for everyone.