A HOLISTIC MODEL for HEALTH & WELLNESS in THE WORKPLACE

1. A HOLISTIC MODEL for HEALTH & WELLNESS inTHE WORKPLACE Jonathan I. Robison, PhD, MS Kelly Putnam, MA

2. TRADITIONAL HEALTH PROMOTION • Disease Focus

3. MEDICALIZATION “A process by which nonmedical problems become defined and treated as medical problems, usually in terms of diseases or disorders” Sobal, 1995

4. OBESITY & MORTALITY “ Obesity is the second leading cause of preventable death in the United States, exceeded only by cigarette smoking …and it contributes to 300,000 deaths annually in the United States.” Manson, NEJM 1996;335:659

5. OBESITY & MORTALITY Actual Causes of Death in the United States McGinnis, JAMA 1993;270(18):2208

6. CAUSES OF DEATH - U.S. 1990 Tobacco 400,000 Diet/activity patterns 300,000 Alcohol 100,000 Microbial agents 90,000 Toxic agents 60,000 Firearms 35,000 Sexual behavior 30,000 Motor vehicles 25,000 McGinnis, JAMA 1993;270(18):2208

7. MENOPAUSE “We salute our heroes. Our mothers, grandmothers, sisters and daughters. Every women who has ever overcome heart disease, cancer, osteoporosis, menopause and depression. Survivors ...remind us to take care of ourselves and make lifestyle choices that can protect us from disease.”

8. TRADITIONAL HEALTH PROMOTION • Disease Focus • Risk Factors

9. “RISK FACTOR FRENZY” • Health = Absence of Risk Factors • Health Promotion = Risk Factor Reduction

10. RISK FACTORS How well do they predict disease? • Heart Disease • Prostate Cancer

11. RISK FACTORS “ Have proved to be quite poor at discriminating at the individual level between those who eventually develop disease (over a certain time period) and those who do not.” Rockhill, AJPH, 2001;91(3):365-368

12. THE CONSEQUENCES • Anxiety & Confusion • Loss of Professional Credibility

13. “RISK FACTOR” RESEARCH “ We are fast becoming a nuisance to society…People don’t take us seriously anymore, and when they do take us seriously, we may unintentionally do more harm than good.” Dr. Dimitrios Trichopoulos, Harvard School of Public Health

14. TRADITIONAL HEALTH PROMOTION • Disease Focus • Risk Factors • Fear, Guilt & Shame

15. TRADITIONAL HEALTH PROMOTION • Disease Focus • Risk Factors • Fear, Guilt & Shame • Behavioral Control

16. SKINNERIAN “BEHAVIORISM” REINFORCEMENT Behaviors that are followed by rewards are likely to be repeated

17. B.F. SKINNER: ON LOVE When two people meet: “One of them is nice to the other and predisposes the other to be nice to him, and that makes him even more likely to be nice. It goes back and forth, and it may reach the point at which they are very highly disposed to do nice things to the other and not to hurt. And I suppose that is what would be called being in love.” Walden II

18. BEHAVIOR MODIFICATION • The Skinnerian approach to motivation is rarely questioned… • There is substantial evidence that rewarding people in this manner retards learning, suppresses creativity, inhibits productivity, and reduces intrinsic motivation.

19. BEHAVIOR MODIFICATIONHealth Promotion • Rewards & Incentives • Competitions • Contests • Risk-Rated Insurance

20. BEHAVIOR MODIFICATION “People’s interest in what they are doing typically declines when they are rewarded for doing it…Rewards... actually undermine the intrinsic motivation that promotes optimal performance.” Kohn, Punished By Rewards

21. ADVERSE CHILDHOOD EXPERIENCES (ACE) STUDY • Almost 10,000 adults in an HMO • 7 categories of childhood trauma • Health risk behaviors & disease Felitti, Am J Prev Med 1998;14(4):245-258

22. CAUSES vs. SYMPTOMS • 28% of women reported sexual abuse • 16% of men reported sexual abuse • 25.6% lived with substance abuser • 10.8% reported physical abuse Felitti, Am J Prev Med 1998;14(4):245-258

23. CAUSES vs. SYMPTOMS • 50% reported at least 1 category • 25% reported at least 2 categories • 6% reported at least 4 categories Felitti, Am J Prev Med 1998;14(4):245-258

24. Disease, Disability & Social Problems Health-Risk Behaviors Social, Emotional, Cognitive Impairment Adverse Childhood Experiences Felitti, Am J Prev Med 1998;14(4):256

25. Behavioral Coping Smoking, Drinking, Drugs, Overeating, Overworking, Sedentary Lifestyle Suffering Anxiety, Anger, Fear, Depression, Hopelessness Root Causes of Behavior Poverty, Abuse, Violence, Isolation

26. CAUSES vs. SYMPTOMS “ The magnitude of the difficulty of introducing the requisite changes into the medical and public health research, education and practice can be offset only by the magnitude of the implications that these changes have for improving the health of the nation.” Felitti, Am J Prev Med 1998;14(4):245-258

27. TRADITIONAL HEALTH PROMOTION • Disease Focus • Risk Factors • Fear, Guilt & Shame • Behavioral Control • Professional as Expert

28. PROFESSIONAL as EXPERT • Client as passive recipient who naturally gravitates towards “unhealthy” behaviors • Professional as powerful, expert provider to police behaviors and prescribe changes to save people from themselves • Goal is behavior change through compliance

29. COMMUNITY HEALTH CONCERNS • Drug abuse 47% • Alcohol abuse 34% • Violence 31% • Drinking and driving 28% • Poor parenting 23% • No health insurance 21% • Poverty 19%

30. COMMUNITY HEALTH CONCERNS • Tobacco use 13% • Teenage pregnancy 12% • Homelessness 9% • Poor diet / lack activity 7% • Emotional problems 5% • Serious mental illness 4%

31. “EXPERT” CONCLUSIONS “Personal health issues, such as diet, exercise and smoking, are not connected to community health in many people’s minds, suggesting…to health professionals a need for education about the implications to the community.” Perceptions of Health & Health Care in The Capital Area Community, 1997.

32. TRADITIONAL HEALTH PROMOTION • Disease Focus • Risk Factors • Fear, Guilt & Shame • Behavioral Control • Professional as Expert • Individual Focus

33. INDIVIDUAL FOCUS • Disease or illness seen as primarily a result of individual lifestyle choices • Failure to account for the person and his or her social, ecological context

34. INDIVIDUAL FOCUS “ A voluminous body of evidence has demonstrated that social class is one of the major, and perhaps even the major risk factor for disease” Minkler, Health Education Quarterly, spring 1989

35. TRADITIONAL HEALTH PROMOTION • Disease Focus • Risk Factors • Fear, Shame & Guilt • Behavioral Control • Professional as Expert • Individual Focus

36. DOES IT WORK? “ While short term changes in attitudes and behavior are common, there is little evidence that these changes last after programs end” O’Donnell, The Art Of Health Promotion, 1997

37. “HOLISTIC” HEALTH PROMOTION • Holistic Health Focus

38. HOLISTIC FOCUS Emphasizes That The Interrelationships Among Spiritual, Biological, Psychological And Social Factors Are Critical To Health And Healing

39. HEALTH DEFINED • World Health Organization “ Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

40. OPTIMAL HEALTH?? “ Complete well-being is a fantasy… health (whatever else it might be) is something that happens not so much in the absence of illness as in its presence.” David Morris

41. If you can start the day without caffeine If you can be cheerful, ignoring aches and pains If you can resist complaining and boring people with your troubles, If you can eat the same food everyday and be grateful for it, If you can understand when loved ones are too busy to give you time,

42. If you can overlook when people take things out on you when, through no fault of yours something goes wrong, If you can take criticism and blame without resentment, If you can face the world without lies and deceit, If you can conquer tension without medical help, If you can relax without liquor, If you can sleep without the aid of drugs,

43. REDEFINING HEALTH “ Health can be redefined as the manner in which we live well despite our inescapable illnesses, disablilities and trauma.” David Morris

44. “HOLISTIC” HEALTH PROMOTION • Holistic Health Focus • Supportive Factors

45. SUPPORTIVE FACTORS forHEALTH & HEALING • Purpose in Life • Spiritual Connections • Social Support • Work Satisfaction • Optimism/Hopefulness • Perceived Health • Pleasure and Play • Ability to Express Emotions

46. “HOLISTIC” HEALTH PROMOTION • Holistic Health Focus • Supportive Factors • Happiness, Meaning & Purpose

47. HAPPINESS, MEANING & PURPOSE Reason for change is primarily to enhance a sense of purpose and enjoyment of life

48. SPIRITUAL CALLING “Every crisis a person has over the age of 30 is a spiritual crisis. Spiritual crisis requires spiritual cures.” Carl Gustav Jung

49. “HOLISTIC” HEALTH PROMOTION • Holistic Health Focus • Supportive Factors • Happiness, Meaning & Purpose • Internal Trust

50. INTERNAL TRUST • People are currently doing the best they can given their particular circumstances • People have a natural desire and ability (internal wisdom) to be healthy