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Sick of SickCare?
The Big Secret ---
Whole Population
Wellbeing Maximization
Dr Roger Jahnke, OMD
Health Action Synergies
http:HealthAction.net
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
StrikingProjection
Kaiser 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:Health, Wellness,Life
Mind-Body Practice
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 T
MISSION• National Financial Bailout• Health Patriotism• Recovery of Citizen Self - Reliance
CONTINUUM
Health Coach
Informed Citizen
Disease Intervention
Wellbeing Maximization
Hospice
Self-Managed Care
Physician
NEXUS
Health Self-Reliant Citizen
Medically Managed 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
Diagnosis
Treatment
WellnessMedicine
Self Inquiry
Personal Plan
Personal Action
Group Support
HealthPromotion
Consultation
Diagnosis
Treatment
ConventionalMedicine
Genuine Health Care
The Public
Consultation
Diagnosis
Treatment
WellnessMedicine
Self Inquiry
Personal Plan
Personal Action
Group Support
Mind-BodySelf-Care
Consultation
Diagnosis
Treatment
ConventionalMedicine
Risk and Cost
$3.93
$5.07$5.93
$5.81
ROI Wellness ProgramsPelletier,Eddington, Goetzel, etc.E
• Heart disease• Cancer• Stroke• COPD, pneumonia
& flu• Accidents • Diabetes• Suicide• Kidney disease• Liver disease
Conventional
10LeadingCauses of DeathNational Vital Statistics Report, Volume 53, Number 5
• Tobacco
• Diet/activity patterns
• Alcohol
• Microbial agents
• Toxic agents
• Firearms
• Sexual behavior
• Motor vehicles
• Illicit use of drugs
Sea Change- -
9ActualCauses of DeathJournal of the American Medical Association,
McGinnis and Foege, 270:2207-2212, 11/93
Recent ResearchGlobal Epidemiology
The Lancet – July 2012Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy
I-Min Lee, Eric J Shiroma, Felipe Lobelo, Pekka Puska,
Steven N Blair, Peter T Katzmarzyk
“Danger of inactivity is equal to danger of tobacco use!”
• Lack of information and healthful lifestyle skills
• Compromised self-efficacy• External & internal stress• Low self-esteem• Mis-information about
necessity of medical expertise
• Anger and frustration• Disempowered, fear
driven • Economic disparity• Confusion – No Plan
Sea Change+- -
8RootCauses of DeathHealth Action, Inc., 1999, 2002, 2007, 2011,
2012
Mind-BodyParadigm
Golden KeysRelaxation Response
vs Stress Response=
Behavioral Prevention
Coaching Mind-Body Practice
Mind-BodyPractice
•
Tai ChiQigongYoga
Mindfulness
Recent ResearchAmerican Journal of
Health Promotion (AJHP)
A Comprehensive Review of the Health Benefits of Qigong and Tai Chi
AJHP, Jahnke, Larkey, 6/2010
9 Health Outcomes
0 5 10 15 20 25 30
Psychological
Immune Function and Inflammation
Quality of Life
Falls Prevention and Balance
Osteoporosis
Immune Function
Patient Reported Outcomes
Self-efficacy
Cardio Pulmonary Effects
Neuro - Psychological
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.
Lancet1st paragraph, 1st sentence
“Ancient physicians—including those from China in 2600 BC and Hippocrates around 400 BC—believed in the value of physical activity for health. By the 20th century, however, a diametrically opposite view—that exercise was dangerous—prevailed instead.”
Physiological Mechanisms
• Oxygen delivery• Acceleration of water–lymph• Autonomic balance• Neuro-transmitter shift • Immune function
Relaxation Response (RR)
• Shift Autonomic – Sympathetic > Parasympathetic
• Adrenergic NT > Cholinergic NT• Hypertensive > Normotensive• Intrinsic Lympahtic ++• 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 Sudarshan Kriya 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
Longevity and
Anti-Aging
Fountain of Youth
Sample Programs- Tai Chi Easy
- Mind-Body Max
• 1000 Practice Leaders Trained• Fitness, spa, community center,
hospital, corporation, school, social service, faith, military
Coaching
HealthWellness
Life
Empowerment Zones• Nutrition
• Exercise• Stress Mastery• Relationships• Finances• Work• Play• Health Care• Environment• Purpose• Self-Esteem• Spirit
The CoL Process• Circle of Life Self-Assessment, 12 areas of 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 ResearchHealth Coaching
UC Santa BarbaraDepartment of Economics
A Group-based Wellness Intervention in the Laboratory:Economic Implications of Health Coaching
Drs Charness and JahnkeB.E. Journal of Economic Analysis & Policy
March, 2012
3 Compelling Findings
1. Participants learned to slow their heart rate – control could not.2. Participants, with no specific instruction, increased weekly exercise by +36min, control decreased -5 min.3. By simply slowing the heart rate (stress mastery) and increasing physical activity (added weekly exercise), $9.5 billion could be saved annually in prevented heart attacks alone.
DeliveryWith Coach
Self-Directed
Live solo
Web Wizard
Live group
Phone solo
Live group
Coach -Assisted
POWERS OF THEWEB WIZARD
• Ubiquitous access – facility, home, mobile, workstation• Marketing – both pre and post member• Social net working• Integrated with the electronic medical record• Robust research potential
CONCLUDING
Good NewsTax and Premium Incentives
“The Affordable Care Act raises the maximum allowed size of wellness incentives, which will lead to differences in insurance premiums between users and nonusers of programs.”&“The Affordable Care Act expands the ability of employers to reward workers who 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 delivery context, can scale in great magnitude allowing the nexus of health care to be health maximization focused in schools, fitness centers, YMCAs, social service agencies, faith based ministries, the military and VA, corporations, professional associations and 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 is preventable ---
• 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.
R U Ready?Already Involved?