(Reprinted by the Kind Permission of Steven Jonas
and the Springer Publishing Company)
Talking About Health and Wellness With Patients:
Integrating Health Promotion and Disease Prevention
into Your Practice
by Steven Jonas
Chapter One - Introduction
I. WHAT'S IT ALL ABOUT?
Health and wellness. You know the drill. If one does them right the risk of contracting a wide variety of diseases can be reduced, or at least their onset can be delayed. Various aspects of health living can improve one’s fitness level, help in weight loss, improve physical appearance, enable the handling of life’s stresses more productively, lead to a better family life, and so on and so forth. Finally, perhaps the most important benefit of healthy living is that most who do it feel better and feel better about themselves, now.
In 1996, referring to regular exercise, the Surgeon General of the United States, Dr. Audrey Manley (United States Department of Health and Human Service, 1996) put it this way:
Scientists and doctors have known for years that substantial benefits can be gained from regular physical activity…We have today strong evidence to indicate that regular physical activity will provide clear and substantial health gains. (p.v)
To say nothing of the “feel good”gains.
Yet while most Americans know that what Dr. Manley said is true, not only in terms of physical activity, but also in terms of the wide range of health promoting behaviors, not too many Americans act on the available knowledge. Thus not too many of us lead a balanced, healthy lifestyle. However, that Americans as a people are not particularly healthy in term of risk-factor control, for example, is not due to a lack of effort in providing information about health and wellness to them. Many, many books and articles on both subjects have been written, are being written and will be written, to say nothing of all the information that appears every day on TV, on radio, in the newspapers, and on the Internet.
There are in fact a host of reasons why Americans are not a particularly healthy population when it comes to such matters as body weight, diet, physical activity, stress-handling capability, and alcohol abuse, for example. Many personal societal, and environmental factors are on the list. But among the reason also is the approach of many in the health professions who, if they deal with the subject at all, often focus on the strictly behavioral method: “Just follow this series of practical steps in eating, or exercise, or stress management, and you will arrive at the desired endpoint.”
The instructions, (and they are often just that, instructions) concern almost entirely what to do, with little attention paid to wither understanding what health and wellness are or the mental processes required in order to engage in them. This book is constructed on a different premise: that an understanding of both the nature of healthy living and the mental process underlying successful personal behavior change is for many people essential if they are going to get where they want to go. This book is designed to help health professionals and health professions students acquire that central understanding themselves, and in turn to equip them to help their patients/clients acquire it as well.
II. WHAT THIS BOOK IS ABOUT
This book is about personal health and wellness and how clinicians can productively talk about them with patients and clients.
At any given time, the health status of an individual is determined by three broad groups of factors: genetic, environmental, and personal/behavioral. All are important. All are constantly interacting with each other over time in a complex, dynamic, three-dimensional feed-back loop.
Health (or lack of it) is, of course, a characteristic not just of individuals but also of groups of people. Thus the health status of communities, societies, nations, geographic regions, and the Earth itself, as well as that of individuals, can be analyzed and described. And the health status of each level of social organization has an impact upon the health of each member of the human species, to a greater or lesser extent depending upon where one lives and what one's socioeconomic status is.
This book, however, does not take on health globally. Rather, it focuses on personal health, with the major emphasis being on what a person can do to promote his or her own health. At the same time, both the genetic and environmental factors influencing personal health will be discussed as relevant and necessary.
As Dr. Lester Breslow has said (1996):
"[L]ifestyle consists of ways of living, the patterns of behavior, in the circumstances of one's life. Increasingly in industrialized society we create for ourselves, individually and collectively, both the circumstances of life and our ways of living in those circumstances. And we are beginning to recognize that both those facets of lifestyle strongly influence how long we live and how well."
Within the realm of personal health, recognizing full-well that they do not comprise the whole story, the book's primary focus is on that group of health-influencing behavioral factors that are or can be under a person's control. We will examine how they affect one's health, how people can make changes in their own behavior(s) to promote their own health, and how clinical practitioners of all kinds can help them to do that.
The straightforward cognitive/behavioral approach to individual behavior and behavior change (Blair; Ferguson; Halper; Liebman; Simmons) has much popularity in the United States. It has much to recommend it, too, at least for certain patients/clients. Taking a somewhat different approach, however, this book is based on the assumption that going beyond the purely behavioral approach will significantly strengthen the hand of the health professional in facilitating positive change in personal health-related behaviors.
The premise is that if, before engaging in straight behavioral interventions, the clinician first has a solid understanding of the theoretical basis of the subject at hand he or she will be better equipped to help the patient/client to improve their health. Too, the same understanding, shared with them by the knowledgeable health professional, can help many patients and clients in their own behavior change endeavours. Hopefully, the "Ten Central Concepts of Health Promotion/Disease Prevention" presented and elaborated upon in this book will provide for the reader a framework for the development of that theoretical understanding in the health and wellness arena.
There is nothing magical or mystical about these Ten Concepts. For the most part, each one simply restates an element of received wisdom about the substance and processes of health and wellness and how people can become healthy and well. The central idea here is that theory can inform practice and be the handmaiden of it. And further, that the active use of theory on a day-to-day basis can make practice both better for the patient/client and more rewarding, fun if you will, for the practitioner.
III. THE ORGANIZATION OF THE BOOK
Aiming to achieve these goals, this book has two parts. The first, comprising chapters one-four, is devoted to introducing the subject and then explaining and analyzing the theoretical basis of the personal health promotion/disease prevention (HP/DP) interventions that can help individuals achieve health and wellness.
In this chapter, after this brief overview of the book, we explore some of the definitions of health and wellness that have been offered over time, and of several related terms/concepts, such as disease and illness. Then, in chapter two, we consider the question: "Why Health Promotion/Disease Prevention?" Chapters three and four explain and discuss the theoretical/definitional underpinnings of the "Ten Central Concepts of Health Promotion/Disease Prevention."
The second section of the book, comprising chapters five-seven, shows how this theoretical understanding can be used in practice to help patients/clients take control and make personal health promoting behavior change(s). The discussion of using the Ten Central Concepts in effectively communicating with patients/clients about personal HP/DP begins with a presentation (chapter five) of the primary functions of the health professional during the encounter with an individual client/patient. They are: assessing, evaluating, educating, recommending, prescribing, and facilitating. Within the limits of a chapter-length discussion of this subject (to which whole books have been devoted), drawing on the work of Jane Westberg and Hillard Jason (1996), these subjects will be elaborated upon.
Next, chapter six illustrates how, using exercise promotion as the example, the Ten Concepts themselves can be applied in a given clinical situation, in this case helping a patient or client to become a regular exerciser. The book concludes, in chapter seven, with a consideration of the process the health professional should/could go through if he or she is to routinely include health promotive/disease preventive interventions in his/her practice.
IV. THE TEN CENTRAL CONCEPTS OF HEALTH PROMOTION/DISEASE PREVENTION
The Ten Concepts are:
- I. Health is a state of being; wellness is a process of being.
- II. Health status is determined by a broad range of factors.
- III. Health has a natural history.
- IV. Central to the wellness process is a wide array of interventions.
- V. Success in certain behavior change endeavours is relative.
- VI. Risks to health can be reduced; in few instances is there certainty of outcome.
- VII. Achieving balance is the essence of healthy living and wellness.
- VIII. There is a common pathway to success for most personal behavior change efforts.
- IX. Motivation is a process, not a thing.
- X. Assessment, goal-setting, and mobilizing motivation are the central tasks in personal behavior change.
The Ten Central Concepts fall into two groups. The first seven are the primarily "substantive" common denominators of healthy, and well, living. These Concepts define and describe what health and wellness are and are about, what their theoretical and philosophical substance is, and how they (that is, health and wellness) may be characterized and understood, both in individuals and in the abstract.
The "process" Concepts are the common denominators of how individuals change their behaviors. They describe the routes one takes to get to a healthy/well state of being, using the seven substantive Concepts to inform the process. These last three Concepts thus deal with just how one goes about becoming and being both healthy and well, about how to incorporate health and wellness into one's life, on the personal level.
Of course, each Concept has elements of both substance and process, but they are grouped according to which element is the most prominent in each Concept. The first seven Concepts are presented in chapter three, the latter three in chapter four. To lay the necessary ground-work for understanding the Ten Central Concepts and how to use them, let us look at definitions of the term "health" and its relatives that have been developed by a number of authorities over time.