Health Reform and Integrative Care

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As health care reform heads into the next phase, Congress will miss the boat if it ends up perpetuating a system that reacts to illness rather than preventing it. Chronic diseases such as obesity, hypertension, and diabetes wreck our quality of life and cost a fortune. For obesity alone, according to The Centers for Disease Control (CDC), the annual medical price tag in the United States is $147 billion.

In recent years there has been debate about whether preventive services would actually lower health costs.

Would savings to programs like Medicare be blunted because healthier patients tend to live longer - and therefore ultimately pile up more medical costs - than patients who die sooner of their chronic diseases? But an article in this month's American Journal of Public Health by Dana Goldman Ph.D. and his colleagues suggests that preventive medicine saves money along with lives. In fact, the authors calculated that a middle-aged person successfully treated for obesity, hypertension, and diabetes would gain about six years of life and, despite living longer, could save as much as $55,000 in lifetime medical spending.

Preventive medicine must become an integral part of health care reform. Counseling and other lifestyle interventions are effective in the treatment of diabetes, hypertension, and smoking. And in recent years, a new and intriguing concept has emerged in the prevention and treatment of chronic illness: the health coach.

I learned about health coaching during a trip to Duke Integrative Medicine, which has pioneered its use. Dr. Tracy Gaudet, Executive Director of Duke Integrative Medicine, explained, "There is currently no one in the healthcare system who has the job or the expertise to actually help people make the lifestyle and behavior changes that they want to make. It is hard to change engrained behaviors. The Integrative Health Coach is trained to help people clarify their personal health goals and achieve them." I saw an example when I interviewed health coach Linda Duda and her patient, Nasera Hassan, a woman with type II diabetes who was having trouble sticking to her doctor's prescribed regimen of exercise, diet, and medication. Hassan told me, "I think when you're so busy with life in general you forget to take medication. You forget to make your appointments for exercise. You don't really think about how you're eating or what you're eating."

With the blessing of her physician, Hassan agreed to try a health coach. She and Duda spoke by phone once a week for six months. Hassan credits Duda with dramatically improving her attitude and helping her navigate towards a healthier lifestyle.

Research supports the role of interventions that improve patient motivation. A ten-month study at Duke found that an integrative medicine approach that includes health coaching can reduce the 10-year risk of cardiovascular disease.
As Gaudet explains, "Incredible amounts of money are spent on largely preventable illnesses rooted in lifestyle choices. Our current health care system is not designed to address this issue. Integrative Health Coaches can work in conjunction with doctor's offices or health systems, or they can be community-based in churches, synagogues, and barber shops."

We need many other innovative ideas like health coaching if we are going to make any dent in chronic health diseases. Health care reform will miss a golden opportunity if all it does is sign more people up for our current system - one that fails to nurture wellness. We know that preventive medicine saves lives and money; it must be at the very core of a reformed health care system.

To view a video about my day at Duke Integrative Medicine, which included acupuncture, Reiki, and mindfulness-based stress reduction as well as interviews with members of the Duke team and the patient-health coach pair mentioned above, click below:


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For the website of Duke Integrative Medicine, click here.

For the website of The National Center for Complementary and Alternative
Medicine, click here.

For the website of The American Board of Preventive Medicine, click here.

For the website of The American College of Preventive Medicine, click here.