Part 1/2 Preventive Healthcare and Wellness: What Are They and Are They Important?
This is a two-part series where I examine the preventive healthcare and wellness industry to explain why businesses in this space are booming and what the future holds for the health of the global population. Part one will define and determine what exactly preventive healthcare and wellness is and their role in our lives. Part two will cover the prediction for what the future holds for preventive healthcare and how they can positively affect population health.
If you work with a startup or a corporation with progressive work culture, you probably have access to free gym memberships, yoga classes, and even meditation sessions. These are just some of the wellness initiatives that companies provide to their employees to improve their mental and physical health, in hopes of improving productivity and reducing health insurance costs. These workplace initiatives are just a small portion of the services offered in the preventive healthcare and wellness space and are definitely nice perks to have if you work with a great company, but what if you don’t have access to such perks? What other services are available in the preventive healthcare and wellness space?
Preventive healthcare? What is it?
First, let us define what is preventive healthcare and wellness. According to the United States’ Centers for Disease Control and Prevention (CDC), preventive healthcare is defined as the following:
Preventive care includes health services like screenings, check-ups, and patient counseling that are used to prevent illnesses, disease, and other health problems, or to detect illness at an early stage when treatment is likely to work best.
As you can see, the definition of preventive care is mainly focused on screening and detecting illnesses and disease to prevent them from becoming more severe.
According to the three different stages of prevention, preventive care under the CDC’s definition is only a secondary measure where it aims to reduce the impact of a disease or injury that has already occurred. It is like using a thermometer to check on the temperature of your chilled food and prevent it from going above 41F, the danger zone; it is essentially a safety measure to stop illnesses in their tracks.
Some of you may hold criticism against Obamacare, but ever since it came into effect, millions of people with insurance coverage now have FREE access to preventive care services such as blood pressure, cholesterol, diabetes, and cancer tests, well-woman visits, HIV tests, and vaccination for children.
What we really need though is primary stage prevention where we aim to prevent disease or injury before it ever occurs. Perhaps wellness could be that primary measure?
Well, well, well, what exactly is wellness?
Ben Zimmer wrote a detailed New York Times Magazine article on the origin of wellness, where he explored how and when the term wellness came to be. According to Ben, “though the Oxford English Dictionary traces wellness (meaning the opposite of illness) to the 1650s, the story of the wellness movement really begins in the 1950s.”
This was in response to the preamble of the the World Health Organization’s 1948 constitution: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Despite much work being done to develop and establish the concept and practice of wellness, it wasn’t until much later in the 1970s when Dr. Bill Hettler, a staff physician at the University of Wisconsin-Stevens Point founded the annual National Wellness Conference, which lent valuable academic prestige to the wellness movement.
Today, the National Wellness Institute (NWI) that Dr. Hettler co-founded is recognized as an authority on wellness, and they define wellness as
an active process through which people become aware of, and make choices toward, a more successful existence.
Wellness isn’t just about living life free of illnesses, but to live a fulfilling and successful life, beyond merely existing or surviving.
Dr. Hettler also came up with the Six Dimensions of Wellness to evaluate a person’s well-being, and they are: emotional, occupational, spiritual, social, intellectual, and physical. Let’s do a quick breakdown of each dimension to get a better sense of what they represent.
The occupational dimension recognizes personal satisfaction and enrichment in one’s life through work. At the center of occupational wellness is the premise that occupational development is related to one’s attitude about one’s work. Do you feel fulfilled doing what you do?
The physical dimension recognizes the need for regular physical activity and is met through the combination of good exercise and eating habits.
The social dimension encourages contributing to one’s environment and community. It emphasizes the interdependence between others and nature.
The intellectual dimension recognizes one’s creative, stimulating mental activities. A well person expands his or her knowledge and skills while discovering the potential for sharing his or her gifts with others.
The spiritual dimension recognizes our search for meaning and purpose in human existence. It includes the development of a deep appreciation for the depth and expanse of life and natural forces that exist in the universe.
The emotional dimension recognizes awareness and acceptance of one’s feelings. Emotional wellness includes the degree to which one feels positive and enthusiastic about one’s self and life.
It is important that we recognize wellness is the sum of all these interconnected dimensions in our lives and neither one of them should be neglected. However, does it play a role as a primary preventive measure?
Strictly following the NWI’s definition of wellness described above, I believe that yes, we are able to prevent diseases from occurring through an active process of making informed and conscious choices. What you don’t consume can do you no harm and make sure what you do consume improves your well-being.
So…is preventive healthcare important? How effective is it?
On this front, we will evaluate the effectiveness of preventive healthcare and wellness in reducing overall cost of care and improving health outcomes to determine if their role in public health.
In terms of cost of care, this research published in the New England Journal of Medicine found that preventive healthcare produced mixed results on the overall cost of care. The study explained that the mixed results obtained were due to inefficient allocation of resources across the plethora of illnesses and diseases. For example, providing non-smokers with lung cancer screenings may be an inefficient allocation of resources. However, it is important to note that only tertiary and secondary prevention measures were analyzed in the study.
Obviously, there is no one-size-fits-all solution to providing preventive care and proper targeting on high risk individuals will yield the best costs savings. We will discuss population targeting as a potential for the future in part 2 of this series.
As for the effect of preventive care on health outcomes, there is a general consensus that prevention can improve public health and individuals’ well-being, although no scientific or statistical study has been conducted to confirm or refute this perception. Nonetheless, we can deduce that prevention is considerably important because the US Surgeon General launched a National Prevention Strategy in 2011 to guide our nation in the most effective and achievable means for improving health and well-being. We will elaborate more on the National Prevention Strategy as part of a guide for the future in part 2 of this series.
What about wellness? Does it save us money and prolong our lives?
Unfortunately, the only measurable data and research available for wellness outcomes are derived from workplace wellness programs. Nonetheless, a research brief published by the RAND Corporation “showed that wellness programs are having little if any immediate effects on the amount employers spend on health care.”
The research found that the returns for disease management (secondary and tertiary measure) was $3.80 but only $0.50 for lifestyle management (primary measure)for every dollar invested.
However, when measured for improved employee health or productivity, investment in lifestyle management produced better results, reducing absenteeism by slightly more than one hour per employee-year.
Taking this research into consideration, should we be investing in wellness programs, particularly lifestyle management programs (primary measure)? I would argue yes, we should still invest in wellness despite the low returns on investment, because we are dealing with risk levels that can be managed over the long-term. Even if not all smokers will develop lung cancer, we should still invest in, if not all, a portion of the group to reduce the incidence of lung cancer development.
The different types of prevention measures, i.e. primary, secondary, and tertiary, yield different results in terms of cost savings and improved health outcomes.
Secondary and tertiary measures produce mixed results in terms of cost-savings but generally improve the health outcomes of high-risk individuals as diseases are stopped before the progress further. Nonetheless, there is still a challenge of properly administering screenings and tests to targeted populations to reduce inefficiency.
As for primary prevention measures, i.e. wellness, the return on investment measured in the short term is very low and can be a challenge to accurately calculate. The argument for investing in wellness depends on certain presumptions, for example if we assume that everyone will get Type 2 diabetes then investing in health and nutrition education to reduce sugar intake will be a wise decision.
In the end, it depends on the risk tolerance of employers, governments, and individuals for how much they are willing to invest to prevent an uncertain health disease from manifesting. A low-cost and effective suggestion for wellness and primary prevention would be health and nutrition literacy, which will provide populations the proper knowledge to make informed choices regarding their well-being and make changes to improve their lifestyle.
We will discuss what the future holds for preventive healthcare and wellness and how they can positively affect population health in part 2 of this series.
Thank you for reading and stay tuned for part 2.
Min Xiang Lee is the founder of Flourish Food, a plant-based health company that serves healthy whole-foods, plant-based meals that are diabetic, cancer, and obesity-friendly. Flourish Food’s mission is to help people live healthier and more fulfilling lives through better dietary choices and building a supportive community around food. Inspired by the Blue Zones, Flourish Food sets out to bring both physical and mental well-being to the communities that it serves.