The American Public Health Association (APHA) has endorsed the objectives outlined in the national Healthy People 2010 document. The APHA Chiropractic Health Care Section "serves as a vehicle for chiropractic participation in mainstream public health activities and works to enhance chiropractic communications, education and credibility on public health matters." Primary among these activities is health promotion: enabling people to increase and sustain their level of well-being. Participation in the APHA Chiropractic Health Care Section provides opportunities for the chiropractic profession to contribute to policy decisions, to educate about methods that promote healthy living, and to play a public role in the health care delivery system.
Every doctor of chiropractic should consider joining the chiropractic section of the APHA. As members of the chiropractic profession, we have an obligation to encourage and support initiatives that improve wellness with our individual patients and among the members of our communities at large. Our participation with the APHA represents one method to ensure that our message is available to a greater audience, while allowing us to integrate with other health care providers and agencies.
Many resources within our profession make reference to terms such as wellness, health promotion, and prevention. The ACC Paradigm asserts that "promoting health" is an integral component of the practice of chiropractic. The current accreditation standards of the Council on Chiropractic Education (CCE) include the following statement under the "Purpose of Chiropractic Education": "As a gatekeeper for direct access to the health delivery system, the doctor of chiropractic's responsibilities as a primary care physician include wellness promotion." Similarly, the American Chiropractic Association has endorsed wellness and health promotion as important elements of the profession.
Health promotion models date back to the mythical Greek goddess Hygeia, hailed as the guardian of health, and the view that people can remain well if they live according to reason. This perspective advances the thought that health promotion is more than simple disease prevention, necessarily incorporating all aspects of existence, such as lifestyle choices, diet, exercise, belief systems, stress and coping, and many other facets. Chiropractic as a profession traditionally has embraced a "holistic" perspective, choosing to view the patient as a complete entity, rather than focusing on particular organ systems, anatomical sections, or disease manifestations.
As we consider the concept of health promotion and wellness, especially within the context of chiropractic health care, we confront the disparity between what is taught in chiropractic colleges and what is written about our professional responsibilities. The 2005 Job Analysis of Chiropractic, published by the National Board of Chiropractic Examiners, reports that while nearly all chiropractors claim they instruct patients regarding health and wellness, the percentage of patients who received this advice, as reported by the same chiropractors, ranged from only 40 percent to 65 percent. Apparently, a significant portion of patients being seen for chiropractic care receive no recommendations for health promotion and wellness.
Why is this? Is it because our graduates fail to understand or appreciate the importance of promoting health-optimizing choices? Is it because practitioners themselves do not model appropriate health behavior and therefore are reluctant to provide advice that contradicts their example? Or is it simply that chiropractors do not generally possess the clinical competencies necessary to provide competent guidance in this regard?
Empowering patients to find and sustain their own wellness requires that the practitioner play a role in educating, coaching, encouraging and exemplifying healthy habits and options. Health promotion is helping people make choices to move toward a state of optimal health. This approach requires more from the chiropractic doctor than simply adjusting the patient. It requires active involvement of both the patient and the provider, working together as a team to achieve and maintain wellness.
The CCE is currently reviewing proposed clinical competencies that address health promotion and wellness. These include attitudes, knowledge and skills that will adequately prepare the graduate doctor of chiropractic to effectively facilitate healthy lifestyles and self-responsibility toward attaining wellness. As we incorporate these methods into chiropractic practice, we will be providing a higher level of service and a more comprehensive measure of health care, thus benefiting our patients, our communities and the profession at large.
Joseph Brimhall, DC
President, Western States Chiropractic College;
President, Council on Chiropractic Education
