Integrative Medicine and Public Health

Perhaps the most pervasive and silently accepted crisis in America (and most of the rest of the industrialized world) today is the ill health of our population. With half the adults suffering one or more chronic degenerative diseases, the suffering and costs are staggering. And unnecessary. All of us in integrative medicine are working to change this. But can we do it alone? Practicing our medicine, one patient at a time, no mater how curative and advanced, is simply not enough. An honest look at healthcare, whether conventional, CAM or integrative, forces us to realize that, in the past century, public health did more to improve longevity and decrease morbidity than all our practices combined. The time has come for us to realize that the only way to realize the huge health benefits inherent in our medicine is through collaboration of not just conventional and CAM but also public health.

 

We all realize that we must change the fundamental approach of our healthcare system from its current emphasis on a disease treatment, symptom relief model, to one that deals with the real problem of improving people's health. The research is clear that most ill health and chronic degenerative disease today is due to lifestyle choices, nutritional deficiencies and internal (non-end product metabolites and gut-derived microbial by-products) and external (environmental) toxins (or the new term "xenobiotics").

 

Public health agencies and the integrative medicine community are natural partners. Both:

§       Define prevention as central to healthcare

§       Recognize the importance of health education

§       Recognize the fundamental role of nutrition/malnutrition in disease and health

§       Understand the impact of the environment toxins on health

§       Encourage individual responsibility for health

As practitioners, we practice these principles on an individual basis while public health professional apply these to whole populations.

 

Collaboration between public health agencies and the integrative medicine community will combine the strengths of both. Local, state and federal public health agencies are very effective instruments for population-based approaches to prevention and health promotion. These agencies have tremendous technical expertise, know their communities well and have strong relationships with other public and private healthcare organizations and agencies that are key to advocating for prevention. The integrative medicine community is already an agent for clinical prevention, represents a large community, and brings citizen energy and organization into the process.

 

I am certainly not advocating abandoning primary care nor am I dismissing the wonderful healing potential of a caring and respectful doctor/patient relationship. However, having served for seven years on the Seattle/King County Board of Health, I see so much unfulfilled opportunity for substantial public benefit through collaboration and more thoughtful allocation of limited funds. One of my greatest frustrations being on the board was how few resources we had for true health promotion. According to national healthcare statistics, we spend only 5% of the national healthcare expenditure on public health. I do not know if true of other public health districts, but ours only spent 5% of our budget on health promotion. Five percent of 5% is not much! This is not to disparage contagion control; food, water and air safety, care for underserved populations, etc. These are obviously critical and were the primary reasons for the tremendous public health successes of the past century. But the reality is that virtually all the healthcare system dollars are spent on disease treatment. In my seven years of public health experience, each year saw a progressive replacement of local control and funding with federal directives and allocations, virtually none of which entailed health promotion. The recent (and certainly appropriate) federal prioritization of public health preparation for bioterrorism continues the creation of an environment with little room for health promotion.

 

A growing proportion of public looking for solutions to improving their health. This is why they are flocking to us. Interestingly, the public health officials I've talked with are equally frustrated with the healthcare system's priorities. Health promotion was a driving passion for many who went into public health. However, they now find little time or resources for such activities.

 

Integration of integrative practitioners with public health would provide a collaboration that could significantly increase attention and resources to dealing with the critical issues of fundamentally improving the health of our population using the most effective and efficient thinking and tools.

 

How might this be accomplished? How about CAM and holistic medical practitioners practicing in public health clinics? What better place to practice our healing philosophies than for those who are incarcerated or living in poverty, and suffering so much unnecessary disease. Another possibility is to become a member of the numerous federal and state committees, commissions and advisory boards advising government on all aspects of health care services and funding.

 

Still another way to think about how broadly public health can be applied. Consider the huge impact of iodination of salt and its impact on hypothyroidism. How about public health working with farmers to increase the selenium content of food in selenium deficient areas of the country. The impact on cancer prevention would be huge.

 

Ultimately, each person is responsible for his or her health and lifestyle decisions. None-the-less, there is much we can do to help make being healthier easier. Public health has already (mostly!) taken care of contagion control. Let’s apply this same power to improving the nutrient density of the food supply, decreasing xenotoxin exposure, etc.