Strategic Directions: Practicing in the Age of Health Care Reform

Chiropractors should be pleased to learn that President Obama agrees with our desire to promote wellness rather than disease management or sick care. The President's Affordable Care Act (ACA) passed in 2010, created the National Prevention Council and calls for the development of The National Prevention Strategy to realize the benefits of prevention for all Americans' health. The National Prevention Strategy is critical to the preventative focus of the Affordable Care Act and builds upon the law's efforts to lower health care costs, improve the quality of care, and provide coverage options for the uninsured.

According to Surgeon General Regina M. Benjamin, MD, The National Prevention Strategy will move us from a system of sick care to one based on wellness and prevention. It builds upon the state-of-the-art clinical services we have in this country and the remarkable progress that has been made toward understanding how to improve the health of individuals, families, and communities through prevention. She claims the council knows preventing disease before it starts is critical to helping people live longer, healthier lives and keeping health care costs down. Poor diet, physical inactivity, tobacco use, and alcohol misuse are just some of the challenges addressed with The National Prevention Strategy.

Chiropractors interested in learning more about The National Prevention Strategy, America's Plan for Better Health and Wellness should read the document. It identifies four Strategic Directions and seven targeted Priorities. The Strategic Directions provide a strong foundation for all of our nation's prevention efforts and include core recommendations necessary to build a prevention-oriented society.

Directions and Priorities

The four Strategic Directions address community environments and quality of life issues:

1. Healthy and Safe Community Environments: Create, sustain, and recognize communities that promote health and wellness through prevention.
2. Clinical and Community Preventive Services: Ensure that prevention-focused health care and community prevention efforts are available, integrated, and mutually reinforcing.
3. Empowered People: Support people in making healthy choices.
4. Elimination of Health Disparities: Eliminate disparities, improving the quality of life for all Americans.

The Priorities provide evidence-based recommendations that are most likely to reduce the burden of the leading causes of preventable death and major illness. The seven Priorities are:

I. Tobacco Free Living

Tobacco use is the leading cause of premature and preventable death in the United States. Living tobacco free reduces a person's risk of developing heart disease, various cancers, chronic obstructive pulmonary disease, periodontal disease, asthma and other diseases, and of dying prematurely.Tobacco free living means avoiding use of all types of tobacco products—such as cigarettes, cigars, smokeless tobacco, pipes and hookahs—and also living free from secondhand smoke exposure. Recommendations include:

1. Support comprehensive tobacco free control policies.
2. Support full implementation of the 2009 Family Smoking Prevention and Tobacco Control Act.
3. Expand use of tobacco cessation services.
4. Use media to educate and encourage people to live tobacco free.

II. Preventing Drug Abuse and Excessive Alcohol Use

Preventing drug abuse and excessive alcohol use increases people's chances of living long, healthy, and productive lives. Excessive alcohol use includes binge drinking (i.e., five or more drinks during a single occasion for men, four or more drinks during a single occasion for women), underage drinking, drinking while pregnant, and alcohol impaired driving. Drug abuse includes any inappropriate use of pharmaceuticals (both prescription and over-the counter drugs) and any use of illicit drugs.

Preventing drug abuse and excessive alcohol use improves quality of life, academic performance, workplace productivity, and military preparedness; reduces crime and criminal justice expenses; reduces motor vehicle crashes and fatalities; and lowers health care costs for acute and chronic conditions. Recommendations include:

1. Support state, tribal, local, and territorial implementation and enforcement of alcohol control policies.
2. Create environments that empower young people not to drink or use other drugs.
3. Identify alcohol and other drug abuse disorders early and provide brief intervention, referral and treatment.
4. Reduce inappropriate access to and use of prescription drugs.

III. Healthy Eating

Eating healthy can help reduce people's risk for heart disease, high blood pressure, diabetes, osteoporosis, and several types of cancer, as well as help them maintain a healthy body weight. As described in the Dietary Guidelines for Americans, eating healthy means consuming a variety of nutritious foods and beverages, especially vegetables, fruits, low and fat-free dairy products, and whole grains; limiting intake of saturated fats, added sugars, and sodium; keeping trans fat intake as low as possible; and balancing caloric intake with calories, burned to manage body weight. Safe eating means ensuring that food is free from harmful contaminants, such as bacteria and viruses. Recommendations include:

1. Increase access to healthy and affordable foods in communities.
2. Implement organizational and programmatic nutrition standards and policies.
3. Improve nutritional quality of the food supply.
4. Help people recognize and make healthy food and beverage choices.
5. Support policies and programs that promote breastfeeding.

[pb]IV. Active Living

Engaging in regular physical activity is one of the most important things that people of all ages can do to improve their health. Even people who do not lose weight get substantial benefits from regular physical activity, including lower rates of high blood pressure, diabetes, and cancer. Healthy physical activity includes aerobic activity, muscle strengthening activities, and activities to increase balance and flexibility. As described by the Physical Activity Guidelines for Americans, adults should engage in at least 150 minutes of moderate-intensity activity each week, and children and teenagers should engage in at least one hour of activity each day. Recommendations include:

1. Encourage community design and development that supports physical activity.
2. Promote and strengthen school and early learning policies and programs that increase physical activity.
3. Facilitate access to safe, accessible, and affordable places for physical activity.
4. Support workplace policies and programs that increase physical activity.
5. Assess physical activity levels and provide education, counseling, and referrals.

V. Injury and Violence-Free Living

Reducing injury and violence improves physical and emotional health. The leading causes of death from unintentional injury include motor vehicle-related injuries, unintended poisoning (addressed in the "preventing drug abuse and excessive alcohol use" chapter), and falls. Witnessing or being a victim of violence (e.g., child maltreatment, youth violence, intimate partner and sexual violence, bullying, elder abuse) are linked to lifelong negative physical, emotional, and social consequences. Recommendations include:

1. Implement and strengthen policies and programs to enhance transportation safety.
2. Support community and streetscape design that promotes safety and prevents injuries.
3. Promote and strengthen policies and programs to prevent falls, especially among older adults.
4. Promote and enhance policies and programs to increase safety and prevent injury in the workplace.
5. Strengthen policies and programs to prevent violence.
6. Provide individuals and families with the knowledge, skills, and tools to make safe choices that prevent violence and injuries.

VI. Reproductive and Sexual Health

Planning and having a healthy pregnancy is vital to the health of women, infants, and families and is especially important in preventing teen pregnancy and childbearing, which will help raise educational attainment, increase employment opportunities, and enhance financial stability. Access to quality health services and support for safe practices can improve physical and emotional well-being and reduce teen and unintended pregnancies, HIV/AIDS, viral hepatitis, and other sexually transmitted infections (STIs). Recommendations include:

1. Increase use of preconception and prenatal care.
2. Support reproductive and sexual health services and support services for pregnant and parenting women.
3. Provide effective sexual health education, especially for adolescents.
4. Enhance early detection of HIV, viral hepatitis, and other STIs and improve linkage to care.

VII. Mental and Emotional Wellbeing

Positive mental health allows people to realize their full potential, cope with the stresses of life, work productively, and make meaningful contributions to their communities. Early childhood experiences have lasting, measurable consequences later in life; therefore, fostering emotional well-being from the earliest stages of life helps build a foundation for overall health and well-being. Anxiety, mood (e.g., depression) and impulse control disorders are associated with a higher probability of risk behaviors (e.g., tobacco, alcohol and other drug use, risky sexual behavior), intimate partner and family violence, many other chronic and acute conditions. Recommendations include:

1. Promote positive early childhood development, including positive parenting and violence-free homes.
2. Facilitate social connectedness and community engagement across the lifespan.
3. Provide individuals and families with the support necessary to maintain positive mental well-being.
4. Promote early identification of mental health needs and access to quality services.

The American Chiropractic Association states that chiropractors provide nutritional, dietary and lifestyle counseling and the Council on Chiropractic Education asserts that accredited Doctor of Chiropractic Programs train their graduates to promote health, wellness and disease prevention. It has been my experience that progressive chiropractic clinicians promote health and wellness by educating their patients of salubrious lifestyle changes. Finally, the American Chiropractic Association (ACA) has collaborated with the National Wellness Institute (NWI) to offer a wellness certification program for doctors of chiropractic.

Hence, chiropractors are capable of improving the health of the public by offering wellness education and promoting disease prevention. The affordable care act promulgates an integrative health care system that offers holistic and patient-centered care. I recommend that chiropractors participate in the Affordable Care Act health care reform and improve the health of our nation.

Suggestions:

1. Read the National Prevention Strategy.
2. Seek additional training and become a Certified Chiropractic Wellness Specialist.
3. Promote wellness and prevent disease.
4. Collaborate with other health care providers to move us from a system of sick care to one based on wellness and prevention.