The philosophy and substantive development of an Integrative Health Care model has been evolving over the past few decades. According to Clement Bezold in his article Evolving Demands and Demographics in Health Care, “90% of the variance in premature death in modern society is related to factors other than the lack of health care. Currently, the vast majority of morbidity and mortality is associated with lifestyle, genetic, and environmental factors.” According to the Center for Disease Control:
• 7 out of 10 deaths among Americans each year are from chronic diseases. Heart disease, cancer and stroke account for more than 50% of all deaths each year.
• In 2005, 133 million Americans – almost 1 out of every 2 adults – had at least one chronic illness.
• About one-fourth of people with chronic conditions have one or more daily activity limitations.
Many of these chronic diseases are preventable through simple diet, exercise, and healthy lifestyle choices. Clearly, there is a need for our health systems to shift from infection and acute and emergency trauma care towards medical and wellness care targeted at our 21st century health problems. While this does not call for an elimination of our evidence-based biomedical health care, it does call for an integration of biomedicine into health systems designed to address lifestyle modification and reduce environmental and genetic risk factors. According to the Institute of Medicine in their February 2009 Summary Report of Integrative Medicine and the Health of the Public, “the interactions between an individual’s social, economic, psychological, and physical environments, and his or her biological susceptibility to illness and responsiveness to treatment; the nature of the care process, as well as its content; and the often greater health benefit to be had from certain “lower tech” interventions, rather than more costly approaches” are part of a bigger picture needed to create this new health care system. Unfortunately, these factors are often overlooked in our current health care system, which are necessary when working with chronic and preventable disease. The tools needed to move our health care system towards one that addresses lifestyle, environment, and genetics and takes into account environmental factors, biological susceptibility and responsiveness, the care process, and lower tech inventions are already at our finger tips. We have the technology to detect early risk factors, know the best preventative measures and lifestyle interventions needed, have a rich array of health care practices and theories of medicine, and we understand the motivations and interventions need to modify human behavior on both an individual and community wide scale.
The factors needed to refocus our health systems, however, are at times in direct conflict with major trends in health care. In an effort to address them as quickly as possible, often the most effective answer is considered too difficult to achieve (for reasons such as finances or logistics) or is simply missed because the patient interactions with the environment, biological susceptibility and responsiveness, the care process, and “lower tech” interventions are not utilized in solution assessments. Trends in individualized medicine, for example, tends to focus on complex and expensive treatment plans, when often a patient just wants an extra few minutes with the doctor, or just wants the pain to stop which could potentially be managed more effectively with greater cost savings with a service such as acupuncture. Patient demand for maximum level of care, again, also trends towards complex and expensive treatments. Ultimately, a patient wants to be heard and wants the problem to be fixed, and without addressing the root cause and instead focusing on fixing the problem once it has become broken, medical costs and frustration with ineffective and/or slow treatment results become common when treatment and interventions don’t work immediately. Direct consumer advertising of health care interventions and treatment options is also driving up costs because patients are demanding these products and services advertised and providers are at times under pressure to utilize certain products and services. When both provider and patient are under pressure to utilize the same products and services, the result is treatments that may not be the most effective and may be more costly, especially since direct consumer advertising focuses on new innovations and technology which are inherently more expensive. Since current health care financing control is not driven by price and patients are often unaware of the costs of products and services, the trend in direct consumer advertising has few checks and balances. Comprehensive disease management, however, is fortunately a trend that integrative health excels at addressing and this, perhaps, is one of the biggest factors in the growth of integrative health care.
Integration of Complementary and Alternative Medicine is a critical aspect of creating an integrative health care facility; however, the integration of CAM into contemporary western medical facilities, as if they were a few extra silos in the bunch, is not a viable model. CAM is unique is its delivery of care because care encompasses diet and nutrition, spiritual connections, social support, and exercise, just the pieces needed to support this new health care model. The use of CAM modalities without comprehensive wellness and positive lifestyle factors makes these modalities limited. This limited use results in the exclusion of many of the primary reasons CAM is so popular in the first place, ie: patient empowerment and effective treatments from practitioners willing to take the time to listen to their patients. In inclusion of CAM into conventional medical systems often highlights a variety of additional strengths, such as it provides minimalist, non-invasive approaches to early-stage and chronic health conditions, which often confounds the medical industry in an effort to effectively treat without high costs. Many aspects of CAM also meet criteria for safety, efficacy and cost-effectiveness. In addition, CAM is useful in addressing many of the leading trends of healthcare in the United States. CAM, thus, can enter the health care scene as a way to fill in holes that an integrative health system that is focused on lifestyle interventions, environmental factors, and genetic/biological factors, without reinventing the wheel. Looking forward, integrating CAM into current health care systems, therefore, requires a reassessment of our current strengths and weaknesses as a system, and will seek to develop a model where CAM and Biomedicine are complementary. This kind of synthesis, fortunately, is flexible and adept at addressing the complexity of today’s healthcare and health care cost challenges.