Alert: Comments Due 12/05 on Prevention Strategy of National Prevention/Health Promotion Counci
Written by John Weeks
Monday, 15 November 2010
Alert: Comments Due 12/05 on "Integrative Health Care" in Nation's New Prevention and Health Promotion Strategy
Summary: If you care what "integrative health care" might mean in the nation's plans for health, wellness and prevention, the time is now for input. Three of the top 4 purposes of the National Prevention and Health Promotion Council established under the Obama-Pelosi healthcare overhaul explicitly reference "integrative health care." That Council has issued its "Draft Framework" for a "National Prevention and Health Promotion Strategy." December 5, 2010 is the last day for input. The framework envisions "moving the nation from a focus on sickness and disease to one based on wellness and prevention." But does the framework adequately reflect the principles and value of "integrative health care"? What additions or amendments to this framework are needed? Share yours with the Surgeon General and the Council. Consider sending them here to the Integrator to share community perspectives.
"(1) provide coordination and leadership at the Federal level, and among all Federal departments and agencies, with respect to prevention, wellness and health promotion practices, the public health system, and integrative health care in the United States;
"(2) after obtaining input from relevant stakeholders,
develop a national prevention, health promotion, public health, and
integrative health care strategy that incorporates the most effective
and achievable means of improving the health status of Americans and
reducing the incidence of preventable illness and disability in the
United States; ...
"(4) consider and propose evidence-based models,
policies, and innovative approaches for the promotion of transformative
models of prevention, integrative health, and public health on
individual and community levels across the United States; ..."
What are your ideas for the role
of integrative health care in "moving
the nation from a focus on sickness
and disease to one based on
wellness and prevention"?
On September 15, 2010, this new Council develop a "Draft Framework" including statements of vision, goals and strategic directions." (These are noted below.) The Council then solicits input via the following questions on the site:
What are your general suggestions on the development of the National
Prevention and Health Promotion Strategy (National Prevention Strategy)?
What are your thoughts on the following elements of the Draft Framework: Vision, Goals, Strategic Directions?
What recommendations should be included in the National Prevention Strategy to advance the Draft Strategic Directions?
Do you have suggestions for how the National Prevention Council can
work with state, local, tribal governments, non-profit, or private
partners to promote prevention and wellness?
What prior federal prevention and health promotion efforts could serve as a model for the National Prevention Council?
Additional Comments or Suggestions
Below is the principal content of the Draft Framework. Thanks to sometimes Integrator columnist Taylor Walsh for the heads-up on this opportunity.
_______________________________
THE NATIONAL PREVENTION AND HEALTH PROMOTION STRATEGY
On September 15, 2010 the Surgeon General convened the National Prevention and Health Promotion Council (the Council). They agreed on the framework for the National Prevention and Health Promotion Strategy (National Prevention Strategy) which includes the Vision, Goals, and Strategic Directions. The Council will use the framework to guide development of the National Prevention Strategy.
DRAFT FRAMEWORK
Draft Vision: Working together to improve the health and quality of life for individuals, families, and communities by moving the nation from a focus on sickness and disease to one based on wellness and prevention.
Draft Goals: In order to achieve the vision for the National Prevention Strategy, efforts will be targeted toward the following goals. Each goal can be applicable to every member of the Council and to many public and private partners.
1) Create community environments that make the healthy choice the easy and affordable choice. 2) Implement effective preventive practices.
Draft Strategic Directions: The intent is to use
the Strategic Directions
a) to frame specific actionable proposals to
meet the goals and achieve the vision for the Strategy, and b) as a lens
through which to view federal and non-federal activities in order to identify how they can bets promote wellness and effective prevention.
In large part, the Strategic Directions are designed to address ways to prevent significant causes of death and disability by focusing action on the factors that underlie these causes. Each member of the Council will apply one or more of the Strategic Directions to its work.
The Draft Strategic Directions are:
Active Lifestyles
Address Specific Populations' Needs to Eliminate Health Disparities
Counter Alcohol/Substance Misuse
Healthy Eating
Healthy Physical and Social Environment
High Impact, Quality Clinical Preventive Services
Injury-Free Living
Mental and Emotional Wellbeing
Strong Public Health Infrastructure
Tobacco‐Free Living
ADDITIONAL INFORMATION ON THE FRAMEWORKFurther Explanation of Strategic Directions
There are many high priority health conditions that are not explicitly included in the Strategic Directions. Many illnesses and conditions contribute to significant death and disease but are not among the top five leading causes of death. The specifics for each of the 10 Strategic Directions are still being developed and refined; when fully developed, they will likely encompass a number of subcategories.
For example, eliminating health disparities will be an important component of many of the Strategic Directions. In addition, as a specific Strategic Direction, the National Prevention Strategy could address a number of conditions that disproportionately affect certain sub-populations (e.g., racial/ethnic groups, specific age groups, gender) such as diabetes,
HIV/AIDS, viral hepatitis B and C, infant mortality, homicide, domestic violence and suicide.
As another example, a strong public health infrastructure will allow us to respond to public health emergencies (e.g., natural disasters, terrorism, and infectious disease outbreaks of influenza and other vaccine preventable diseases) as well as to perform essential on-going public health prevention services.
Guiding Principles
The framework was developed in line with the following guiding principles specified in the 2010 Annual Status Report:
Prioritize prevention and wellness.
Establish a cohesive federal response.
Focus on preventing the leading causes of death, and the factors that underlie these causes.
Prioritize high-impact interventions
Promote high-value preventive care practices
Promote health equity
Promote alignment between the public and private sectors.
Ensure accountability
Relationship to Other Administration Initiatives
As the National Prevention Strategy is developed, it will align with strategic initiatives and plans such as Healthy People 2020, Let's Move! Initiative, the National HIV/AIDS Strategy, and the forthcoming National Quality Strategy.
Note: The document concludes with a chart that provides "Rationale" and "Example Programs" for the 1- Draft Strategic Directions.
_______________________________
Comment: There is much that is very exciting here, starting with the vision of shifting toward a focus on health and prevention. That sounds like the mission statements of scores integrative health organizations and initiatives going back decades. Hip-hip-hooray!
Yet clarifying the meaning and role of "integrative health care" in this construct is challenging. Some ideas to me are slam dunks. For instance, yoga in the schools or mind-body practices in the schools would be exceptional programs under the Strategic Direction of "Mental and Emotional Well-Being."
"Excellent
as most components are, the framework presently appears to side-step the
optimal role of clinical services in moving our nation toward a focus on wellness and prevention. These is much room for work here. Let's step up!
Still, most of this framework, excellent as most components are, presently appears to side-step engaging the optimal role of clinical services in moving our nation toward this focus. For instance, there is no explicit mention of health and wellness coaching, a recent, debated Integrator theme. Nor does there appear to be awareness that whole person-oriented integrative care can produce significant secondary health, wellness and preventive outcomes. Witness the Seely-Herman study of the integrative, naturopathic care which found, through patient self-reports: less fatigue, better sleep, lowered weight, diminished stress, fewer allergic symptoms, less hypertension, lower coffee consumption, and fewer muscoloskeletal problems.
The historic estrangement of "public health" and "clinical practice" in the United States is a function of the dominant type of clinical care that focuses almost entirely on reacting to sickness and disease. It behooves members of the integrative care community to seize this moment and redefine, forever, what we mean by "high impact, quality preventive services."
