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Sick of SickCare? The Big Secret --- Whole PopulationWellbeing Maximization Dr Roger Jahnke, OMD Health Action Synergies http:HealthAction.net
Fast Paced Email questions and requests:DrJahnke@HealthAction.net Slides will be posted
70% of disease is preventable Healthy People 2000, DHHS, 1991, #91-50213 National Center For Health Statistics, DHHS, 1992, # 92-1232 8 of 9causes of disease are Preventable (90%) New England Journal of Medicine, Fries, Koop, et al, 329:321-325, 7/93
Striking ProjectionKaiser Family Foundation 2012 = $3 trillion
Industry Watch• AMA• AHA/VHA• NWI, NHWP Congress• Air Force, Veteran’s Administration• YMCA, Fitness, Medical Fitness• IHPM• Numerous hospital systems• Publications - numerous articles in journals and chapters in texts
Distillation of Findings Integrative Medicine & Mind Body Wellness Coaching: Mind-Body Health, Practice Wellness, Life
What is at stakeMONEY $$• $2,100,000,000,000 - $2,800,000,000,000• “Conventional” medicine is programmed to keep the $3 T, AND, until very recently hardly anybody has been going for the $2.1 -- $2.8 TMISSION• National Financial Bailout• Health Patriotism• Recovery of Citizen Self - Reliance
CONTINUUM Disease Wellbeing Intervention Maximization NEXUSHospice Informed Physician Health Citizen Health Self-Reliant Citizen CoachMedically Managed Self-ManagedCare Care
HealthcareOld Paradigm: To clinically assess risk and render clinical procedures to reduce pathology.Pathology based, institutionally based (hospital, clinic), extremely expensive, does not foster citizen self- reliance.
Health CareNew Paradigm: To behaviorally sustain and enhance health through personal action.Health based, community based (home, fitness center, workplace, school), less expensive, fosters health self-reliance.
Conventional Healthcare The Public Consultation Consultation Self Inquiry Diagnosis Personal Plan Diagnosis Personal Action Treatment Treatment Group SupportConventional Health Wellness Medicine Promotion Medicine
Genuine Health Care The Public Consultation Consultation Self Inquiry Diagnosis Personal Plan Diagnosis Personal Action Treatment Treatment Group SupportConventional Mind-Body Wellness Medicine Self-Care Medicine
• Tobacco Sea Change --• Diet/activity patterns 9• Alcohol Actual• Microbial agents• Toxic agents Causes• Firearms of• Sexual behavior Death• Motor vehicles Journal of the American Medical Association, McGinnis and Foege, 270:2207-2212, 11/93
Recent Research Global EpidemiologyThe Lancet – July 2012Effect of physical inactivity on major non-communicable diseases worldwide:an analysis of burden of disease and lifeexpectancy I-Min Lee, Eric J Shiroma, Felipe Lobelo, PekkaPuska, Steven N Blair, Peter T Katzmarzyk“Danger of inactivity is equal to danger of tobacco use!”
• Lack of information and healthful lifestyle skills Sea Change+ --• Compromised self-efficacy• External & internal stress 8• Low self-esteem Root Causes• Mis-information about necessity of medical of expertise• Anger and frustration• Disempowered, fear driven Death• Economic disparity Health Action, Inc., 1999, 2002, 2007, 2011, 2012• Confusion – No Plan
Golden Keys Relaxation Response vs Stress Response = Behavioral PreventionCoaching Mind-Body Practice
Mind-Body Practice • Tai Chi Qigong Yoga Mindfulness
Recent Research American Journal ofHealth Promotion (AJHP)A Comprehensive Reviewof the Health Benefitsof Qigong and Tai Chi AJHP, Jahnke, Larkey, 6/2010
9 Health Outcomes Immune Function Neuro - Psychological Patient Reported Outcomes Self-efficacy Immune Function and Inflammation Falls Prevention and Balance Quality of Life Cardio Pulmonary Effects Osteoporosis0 5 10 15 20 25 30
Compelling Findings• Primary Killer – Heart & Cardiovascular• 19 of the studies found Qigong and Tai Chi safe and effective in the treatment of the greatest killing disease
Compelling Findings• Neuro – Psychological• The most devastating non-killing diseases – stress, anxiety, depression.• 27 studies found Qigong and Tai Chi safe and effective.
Compelling Findings• Balance and Falls Prevention• Among the most expensive preventable diseases.• 24 studies found Qigong and Tai Chi safe and effective.
Lancet 1st paragraph, 1st sentence“Ancient physicians—including thosefrom China in 2600 BC andHippocrates around 400 BC—believedin the value of physical activity forhealth. By the 20th century, however,a diametrically opposite view—thatexercise was dangerous—prevailedinstead.”
Physiological Mechanisms• Oxygen delivery• Acceleration of water–lymph• Autonomic balance• Neuro-transmitter shift• Immune function
RR & Gene Expression• Benson Team - Genomic counter-stress changes induced by the relaxation response 2008 Jul 2;3(7):e2576• Li Team - Genomic profiling in Asian Qigong practitioners: gene regulation by mind-body interaction. Journal of Alternative and Complement Medicine 2005 Feb;11(1):29-39• Sharma Team - Gene expression profiling in practitioners of SudarshanKriya Journal of Psychosomatic Research 2008 Feb;64(2):213-8
RR & Gene Expression“It is becoming increasingly clear that psychosocial stress can manifest as system-wide perturbations of cellular processes, generally increasing oxidative stress and promoting a pro-inflammatory milieu. More recently, chronic psychosocial stress has been associated with accelerated aging at the cellular level. Specifically, shortened telomeres, low telomerase activity, decreased anti-oxidant capacity and increased oxidative stress are correlated with increased psychosocial stress and with increased vulnerability to a variety of disease states.”
Mind-Body Practice =Reduced rate of cell death
The CoL Process• Circle of Life Self-Assessment, 12 areasof Life – Empowerment Zones.• Acknowledge Strengths• Group Based Cost Efficiencies• Blueprint for Success- Acknowledge Victories, Assets- Create Targeted Intentions- Set clear SMART Goals- Recognize Challenges- Target Action Steps- Schedule Action Steps- Mind-Body Self-Care Practices- Accountability
Recent Research Health Coaching UC Santa Barbara Department of EconomicsA Group-based WellnessIntervention in the Laboratory:Economic Implications of Health Coaching Drs Charness and Jahnke B.E. Journal of Economic Analysis &Policy March, 2012
3 Compelling Findings1. Participants learned to slow their heart rate –control could not.2. Participants, with no specificinstruction, increased weekly exercise by+36min,control decreased -5 min.3. By simply slowing the heart rate (stressmastery) and increasing physical activity (addedweekly exercise), $9.5 billion could be saved
Delivery Web Wizard With Coach Live PhoneSelf- solo soloDirected Coach - Live Live Assisted group group
POWERS OF THEWEB WIZARD• Ubiquitous access –facility, home, mobile, workstation• Marketing – both pre and post member• Social net working•Integrated withthe electronic medicalrecord• Robust research potential
Good News Tax and Premium Incentives“The Affordable Care Act raises themaximum allowed size of wellnessincentives, which will lead todifferences ininsurance premiums between users andnonusers of programs.”&“The Affordable Care Actexpands theability of employers to reward workerswho achieve health improvement goals.”
ConfoundingEvidence based (EB) programs and best practices –-- when a particular program in a category is “proven”, it is like advertising for just one program that does what many programs can do, do well and do safely.-- when a best practice is declared, exploration and innovation can tend to be curtailed.-- when a program reaches “evidence based” status – consider the concept as it may be presented in alternative programs.Recommendation – when a programmatic concept is found safe and effective, it is not necessarily true that the only acceptable program is the one that was the basis for the evidence.
ScalingIt is obvious that the mind-body paradigm –Coaching and Mind-Body Practice --implemented in the group based deliverycontext, can scale in great magnitude allowingthe nexus of health care to be healthmaximization focused in schools, fitnesscenters, YMCAs, social service agencies, faithbased ministries, the military andVA, corporations, professional associationsand unions as well as hospitals and clinics.
Fun Questions• Is the future of health care financing in the diagnosis of preventable diseases and medical intervention solutions?OR• Is the future of health care financing in the reallocation of the $3 trillion to wellbeing maximization?
BETTER QUESTION – How will this happen?Does health maximization happen in clinics and hospitals?ORDoes health maximization happen at home, work, school, social service agency, faith ministry, fitness center?
PREDICTIONThis is simple logic:If 70% - 90% of disease ispreventable ---• The nexus of all health care activity will not be the clinic and the hospital.• The $3 trillion will not be going to medicine & medical intervention.