Throughout my long career, I have noted that the "wellness" concept of health care has never been very much appreciated by our society, and have often wondered why more health care resources weren't spent on preventive care.
The feeling was that there was little or no money to be saved in promoting wellness. In fact, it was clear that there would be less income for health professionals if they promoted healthier lifestyles for their patients. Patients pretty much followed the concept of going to the doctor and saying, "Here's my body, doctor. I got it sick, you get it well."
It is only fairly recently that wellness care has begun to draw more attention, and the reason is an economic one. Employers and others now see that there's a great deal of money to be saved by pursuing the wellness goal. In 1994, it was learned that an investment of one dollar in wellness in the workplace could save as much as $3.75.
There is an organization known as the Health Project that was begun during George Bush's administration. The man most associated with the project was Dr. C. Everett Koop, then the surgeon general. The Health Project gives its annual C. Everett Koop awards to corporations and local governments for work done to promote wellness. Such corporate giants as Dupont and Exxon have been recipients of the award, as has Ventura County, California.
What have these recipients accomplished? They have organized and implemented various programs to encourage their employees to follow a few simple maxims:
- exercise regularly;
- get proper nutrition after learning what constitutes proper eating habits;
- stop smoking;
- drink only in moderation;
- wear seat belts;
- lift heavy objects in a careful manner;
- get a complete physical examination annually;
- sit properly;
- avoid overly repetitious movement unless interrupted by contrary movement;
- avoid prolonged sedentary postures by moving about at pre-planned times;
- how to choose a doctor or health plan;
- if pregnant, ask for explanations as to the relative seriousness of any findings;
- seek a second opinion;
- always request information on adverse side-effects of medications (all drugs have them), and make your own judgement and decision on whether the out comes justify the treatment;
- your satisfaction, and the outcomes resulting from the health care you receive, is paramount.
These concepts are somewhat ageless. But, as I've said, at the same time, they have only recently been in part appreciated on an organized level. They are of utmost importance, and any concerted effort to bring about an organized appreciation for them by our community will bring large "payoffs" to us personally and collectively. If we do the few things necessary to maintain our health, then our health will far more infrequently require the intervention of expensive - and often unpleasant - health care treatments.
All businesses, but especially medium and small size businesses, should be especially aware of what can be accomplished through the application of these wellness principles. There are many doctors willing to come to a place of business to educate workers about wellness. I believe you may find, as many have already found in recent years, that your "bottom line" will be favorably impacted. I am also convinced that the very important ingredient of the workplace - employee morale - can benefit. Productivity would almost certainly rise.
Will the momentum toward wellness activities continue or even increase on its own? I believe that it will not and should not! It will take the assertive effort of individuals and groups in our profession, perhaps special committees within state and local chiropractic organizations, to sit down and map out the procedures necessary to encourage and implement these activities and principles in appropriate business environments. After all, as I've just said, organizations, just as must individuals, must take more responsibility for their own health and the health of those whom they employ, not because it may be the right thing to do (although this might be a reason in and of itself), but because it would be a sound business practice, leading to a healthier and more vigorous work force that requires less health care.
Virtually all of the emerging scientific evidence points to the effectiveness of wellness principles in warding off or preventing illness and pain before it occurs, not to mention the degree to which such appreciation lends itself to a more active and productive life. Loss of time from the job is far more expensive to employers than even health care treatment. The Agency for Health Care Policy and Research (AHCPR) of the U.S. Department of Health and Human Resources estimates that costs only related to health care (such as lost time from work; replacement of an injured worker and training of a replacement; the lower productivity of the replacement; and the benefits supplied to the replacement) are is three times the cost of treatment for acute low back problems in adults. Certain Fortune 500 companies have learned that for every 10 million dollars spent on treatment, an estimated 100 million dollars are spent on these related costs. Does this suggest that a modest investment in avoidance of illness or injury might be worth it?
I know of one ongoing study that is exceptionally interesting: A major and very well-known analyzer of the nation's health status was during the past year taking a look at certain groups of senior citizens. To simplify this, let's say a particular group or cohort comprised 100 people. One day, one of the scientific investigators noticed that one of the 100 seemed so much more active and healthy than the rest of the cohort. That member was isolated for closer study. Further evaluation of the group revealed others similarly situated; they were also placed in the special group. Eventually, 34 of the 100 fit into the special category. These thirty-four people ate better, exercised more, were active in their communities, and generally had noticeably better attitudes about life in general. They were truly a group unto themselves. These people were from 70 to 75 years of age! Was there a common ingredient here? Was it as simple as them all getting superior health care?
Not necssarily. Was it just that they all were genetically blessed? We're not sure yet.
The situation so intrigued us that our organization decided to fund a deeper evaluation of these 34 people. When the results of the study come in, we will have an opportunity to discuss them.
As I said earlier, wellness may actually reduce our incomes. It has therefore not often been a point-of-focus for many of us. This publication and other media need to maintain and assert the growing awareness of the extensive benefits of wellness programs. The impetus will not, generally speaking, come from the health care community. The media also needs to encourage the building of bridges of cooperation among the health professions. This would help to incorporate into our health care system the principles of which I speak.
As I conclude, an analogy might be in order: If each of us were given an automobile when we were 16 and told, "This is the only automobile you will ever have. As soon as it breaks down, you will have to walk." How do you feel we would behave? I would wager that each of us would be very certain to get regular oil changes; rotate the tires; replace the windshield wiper blades; have regular tune-ups; wax the car regularly; grease the door and trunk hinges; check the other fluids at appropriate intervals; and do anything else necessary to assure that our automobiles lasted a lifetime.
Paying more attention to our responsibilities to maintain our own bodies (wellness) is increasingly part of our evolving health care system. While the impact of managed care and other "innovations" are being felt by the health professions, for all of it to work properly, we must assume more accountability for our own well being. As competition has entered the health care marketplace, we will increasingly need to think through our options. One of these is to do an ever-improving job of taking care of ourselves.
Jerome McAndrews,DC
Claremore, Oklahoma
