Public Health: The Next Step in Integrative Chiropractic, Part 2

Editor's note: Part 1 of this article ran in the April 8, 2008 issue. A printable version is available online at www.chiroweb.com/archives/26/08/16.html.

"I'm a chiropractor, and sometimes I have been called a 'quack' by people who don't know me very well - and who also aren't very polite!" So began part 1 of this article. The question is, how do we change the negative perception of chiropractors among those who have never been to one (the same negative attitude about chiropractic I used to have before I met a chiropractor and then became one).

Participation in public health offers a tremendous opportunity to change that negative perception because public health is traditionally service-oriented, population-oriented and about the "greater good." However, just as chiropractors feel they have much to teach about wellness, public health also has much to teach. I believe the public-health definition of wellness, if embraced by the chiropractic profession, could lead to greater opportunities for chiropractors and closer cooperation with other health care providers. In other words, public health is the next step in integrative chiropractic.

First, chiropractors often use the word wellness, but what do they mean? If wellness is a code word for passive income, then ultimately it's an empty promise and will only further the negative perception of chiropractors as hucksters. If previous chiropractic media are given a perfunctory review, the word seems to be associated with pictures of young and healthy people doing yoga, purchasing chiropractic services, eating herbs and vegetables and living comfortably in an upper-socioeconomic stratum.

However, I and my public-health colleagues contend wellness is for everyone: the sick and the healthy, the rich and the poor - everyone! As stated in the U.N. Declaration of Human Rights, of which the U.S. and Canada are signatory nations, "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care."

If we agree on this, the chiropractic definition of wellness might need to be expanded to the capacity of the public-health definition. In this context, public-health practitioners talk about primary, secondary and tertiary prevention, rather than wellness.

• Primary prevention is utilized to prevent the incidence or occurrence of a problem in the first place. Here, activities such as improving physical activity and nutrition, preventing initiation of tobacco use and other similar activities occur.
  
• Secondary prevention is utilized to reduce the prevalence of a condition requiring screening to catch problems and correct them early. Here, activities such as cancer screening, tobacco-cessation programs and appropriate biopsychosocial interventions to prevent chronic back pain occur.
  
• Tertiary prevention is utilized to reduce morbidity and mortality in existing conditions that might not be cured. Here, activities such as "Silver Sneakers" programs to improve function and reduce pain in the presence of osteoarthritis, stretching and mobilization to alleviate joint pain in multiple sclerosis patients, and a host of other programs to reduce pain and increase function in chronic and other illnesses occur.

Do you see chiropractic as primary prevention? It seems a good fit - optimizing health through nutrition and exercise. Do you see chiropractic as secondary prevention? It also seems a good fit - treating specific conditions such as back pain or carpal tunnel syndrome, as well as recommending patients for risk-factor screenings. Do you see chiropractic as tertiary prevention? It seems a good fit, too - palliative care for MS, hemiplegia, Parkinson's and other conditions affecting patients.

In that definition of wellness - primary, secondary and tertiary prevention in public health - there is an appropriate role for chiropractic in a broad spectrum of care and in many settings. In other words, public health provides a medium through which chiropractic can serve in integrated settings.

Other health care providers in these settings are willing to work with chiropractors. Other health care providers are aware the American College of Physicians and the American Pain Society both have recommended spinal manipulation as a treatment for low back pain in a joint statement in the Annals of Internal Medicine. But these providers also are aware of negative cultural perceptions of chiropractors. They may have had questionable experiences themselves, yet they know the evidence and want to help their back pain patients. How do those providers know to trust a given chiropractor or chiropractors in general?

I contend public health is a universal currency. Participation in conventional public-health activities and in recognized professional associations such as the American Public Health Association (and its Chiropractic Health Care section) sends a message other providers understand. You are a chiropractor who speaks and understands the same language they do and will care for their patients with ethical concern and best practices. Public health is the key that allows you to be recognized as part of the health care team by those less familiar with chiropractic.

Chiropractors might feel like they are banging on the door of the health care system, demanding to be let in and compete on a level playing field. Instead of insisting to be let in, why not join the APHA and get involved in public health? This is the largest level playing field for chiropractors. It's time to allow participation in public health to open doors for the chiropractic profession - not because we knock on those doors, but because the services we provide open them.

Take a few moments now to download and complete the membership form or log in to www.apha.org and click "join." Don't forget to select the Chiropractic Health Care section as your primary section affiliation. If you have questions about joining APHA, please contact me at j.t.egan@gmail.com. Come be part of something that has the potential to make a difference and change the perception of chiropractic, once and for all. Now is the time to join!