a holistic model for health & wellness in the workplace

Jonathan I. Robison, PhD, MSKelly Putnam, MA

A HOLISTIC MODEL A HOLISTIC MODEL

for for

HEALTH & WELLNESS HEALTH & WELLNESS

inin

THE WORKPLACETHE WORKPLACE

TRADITIONAL TRADITIONAL HEALTH PROMOTIONHEALTH PROMOTION

Disease Focus

MEDICALIZATIONMEDICALIZATION

“A process by which nonmedical problems

become defined and treated as medical

problems, usually in terms of diseases or

disorders”

Sobal, 1995

OBESITY & MORTALITYOBESITY & MORTALITY

“ Obesity is the second leading cause of preventable death in the United States, exceeded only by cigarette smoking …and it contributes to 300,000 deaths annually in the United States.”

Manson, NEJM 1996;335:659

OBESITY & MORTALITYOBESITY & MORTALITY

Actual Causes of Death in the United States

McGinnis, JAMA 1993;270(18):2208

CAUSES OF DEATH - U.S. 1990CAUSES OF DEATH - U.S. 1990

Tobacco 400,000

Diet/activity patterns 300,000

Alcohol 100,000

Microbial agents 90,000

Toxic agents 60,000

Firearms 35,000

Sexual behavior 30,000

Motor vehicles 25,000

McG

innis, JAM

A 1993;270(18):2208

MENOPAUSEMENOPAUSE

“We salute our heroes. Our mothers, grandmothers, sisters and daughters. Every women who has ever overcome heart disease, cancer, osteoporosis, menopause and depression. Survivors ...remind us to take care of ourselves and make lifestyle choices that can protect us from disease.”


Disease Focus Risk Factors

““RISK FACTOR FRENZY”RISK FACTOR FRENZY”

Health = Absence of Risk Factors

Health Promotion = Risk Factor

Reduction

RISK FACTORSRISK FACTORS

How well do they predict disease?

Heart Disease

Prostate Cancer

RISK FACTORSRISK FACTORS

“ Have proved to be quite poor at

discriminating at the individual level

between those who eventually develop

disease (over a certain time period) and

those who do not.”Rockhill, AJPH, 2001;91(3):365-368

THE CONSEQUENCESTHE CONSEQUENCES

Anxiety & Confusion

Loss of Professional Credibility

““RISK FACTOR” RESEARCHRISK FACTOR” RESEARCH

“ We are fast becoming a nuisance to society…People don’t take us seriously anymore, and when they do take us seriously, we may unintentionally do more harm than good.”

Dr. Dimitrios Trichopoulos, Harvard School of Public Health


Disease Focus Risk Factors Fear, Guilt & Shame


Disease Focus Risk Factors Fear, Guilt & Shame Behavioral Control

SKINNERIAN “BEHAVIORISM”SKINNERIAN “BEHAVIORISM”

REINFORCEMENT

Behaviors that are followed by

rewards are likely to be repeated

B.F. SKINNER: ON LOVEB.F. SKINNER: ON LOVE

When two people meet:

“One of them is nice to the other and predisposes the other to be nice to him, and that makes him even more likely to be nice. It goes back and forth, and it may reach the point at which they are very highly disposed to do nice things to the other and not to hurt. And I suppose that is what would be called being in love.”

Walden II

BEHAVIOR MODIFICATIONBEHAVIOR MODIFICATION

The Skinnerian approach to motivation is

rarely questioned…

There is substantial evidence that rewarding

people in this manner retards learning,

suppresses creativity, inhibits productivity,

and reduces intrinsic motivation.


Health PromotionHealth Promotion

Rewards & Incentives

Competitions

Contests

Risk-Rated Insurance


“People’s interest in what they are doing typically declines when they are rewarded for doing it…Rewards... actually undermine the intrinsic motivation that promotes optimal performance.”

Kohn, Punished By Rewards

ADVERSE CHILDHOOD ADVERSE CHILDHOOD EXPERIENCES (ACE) STUDYEXPERIENCES (ACE) STUDY

Almost 10,000 adults in an HMO

7 categories of childhood trauma

Health risk behaviors & disease

Felitti, Am J Prev Med 1998;14(4):245-258

CAUSES vs. SYMPTOMSCAUSES vs. SYMPTOMS

28% of women reported sexual abuse

16% of men reported sexual abuse

25.6% lived with substance abuser

10.8% reported physical abuse



50% reported at least 1 category

25% reported at least 2 categories

6% reported at least 4 categories


Adverse Childhood Experiences

Social, Emotional, Cognitive Impairment

Health-Risk Behaviors

Disease, Disability

& Social Problems

Felitti, Am J Prev Med 1998;14(4):256

Root Causes of Behavior Poverty, Abuse, Violence, Isolation

SufferingAnxiety, Anger, Fear,

Depression, Hopelessness

Behavioral CopingSmoking, Drinking, Drugs, Overeating,

Overworking, Sedentary Lifestyle


“ The magnitude of the difficulty of introducing the requisite changes into the medical and public health research, education and practice can be offset only by the magnitude of the implications that these changes have for improving the health of the nation.”



Disease Focus Risk Factors Fear, Guilt & Shame Behavioral Control Professional as Expert

PROFESSIONAL as EXPERTPROFESSIONAL as EXPERT

Client as passive recipient who naturally gravitates towards “unhealthy” behaviors

Professional as powerful, expert provider to police behaviors and prescribe changes to save people from themselves

Goal is behavior change through compliance

COMMUNITY HEALTH CONCERNSCOMMUNITY HEALTH CONCERNS

Drug abuse 47% Alcohol abuse 34% Violence 31% Drinking and driving 28% Poor parenting 23% No health insurance 21% Poverty 19%

COMMUNITY HEALTH CONCERNSCOMMUNITY HEALTH CONCERNS

Tobacco use 13% Teenage pregnancy 12% Homelessness 9% Poor diet / lack activity 7% Emotional problems 5% Serious mental illness 4%

““EXPERT” CONCLUSIONSEXPERT” CONCLUSIONS

“Personal health issues, such as diet, exercise and smoking, are not connected to community health in many people’s minds, suggesting…to health professionals a need for education about the implications to the community.”

Perceptions of Health & Health Care in The Capital Area Community, 1997.


Disease Focus Risk Factors Fear, Guilt & Shame Behavioral Control Professional as Expert Individual Focus

INDIVIDUAL FOCUSINDIVIDUAL FOCUS

Disease or illness seen as primarily a

result of individual lifestyle choices

Failure to account for the person and his

or her social, ecological context

INDIVIDUAL FOCUSINDIVIDUAL FOCUS

“ A voluminous body of evidence has

demonstrated that social class is one of

the major, and perhaps even the major

risk factor for disease”

Minkler, Health Education Quarterly, spring 1989


Disease Focus Risk Factors Fear, Shame & Guilt Behavioral Control Professional as Expert Individual Focus

DOES IT WORK?DOES IT WORK?

“ While short term changes in attitudes

and behavior are common, there is little

evidence that these changes last after

programs end”

O’Donnell, The Art Of Health Promotion, 1997

““HOLISTIC” HOLISTIC” HEALTH PROMOTIONHEALTH PROMOTION

Holistic Health Focus

HOLISTIC FOCUSHOLISTIC FOCUS

Emphasizes That The Interrelationships

Among Spiritual, Biological,

Psychological And Social Factors Are

Critical To Health And Healing

HEALTH DEFINEDHEALTH DEFINED

World Health Organization

“ Health is a state of complete physical, mental

and social well-being and not merely the

absence of disease or infirmity.”

OPTIMAL HEALTH??OPTIMAL HEALTH??

“ Complete well-being is a fantasy… health

(whatever else it might be) is something that

happens not so much in the absence of illness as in

its presence.”

David Morris

If you can start the day without caffeine

If you can be cheerful, ignoring aches and pains

If you can resist complaining and boring people

with your troubles,

If you can eat the same food

everyday and be grateful for it,

If you can understand when loved ones

are too busy to give you time,

If you can overlook when people take things out on you when, through no fault of yours

something goes wrong,

If you can take criticism and blame without resentment,

If you can face the world without lies and deceit,

If you can conquer tension without medical help,

If you can relax without liquor,

If you can sleep without the aid of drugs,

REDEFINING HEALTHREDEFINING HEALTH

“ Health can be redefined as the manner

in which we live well despite our

inescapable illnesses, disablilities and

trauma.”

David Morris


Holistic Health Focus Supportive Factors

SUPPORTIVE FACTORS forSUPPORTIVE FACTORS forHEALTH & HEALINGHEALTH & HEALING

Purpose in Life Spiritual Connections Social Support Work Satisfaction Optimism/Hopefulness Perceived Health Pleasure and Play Ability to Express Emotions


Holistic Health Focus Supportive Factors Happiness, Meaning & Purpose

HAPPINESS, MEANING & PURPOSEHAPPINESS, MEANING & PURPOSE

Reason for change is primarily to

enhance a sense of purpose and

enjoyment of life

SPIRITUAL CALLINGSPIRITUAL CALLING

“Every crisis a person has over the age

of 30 is a spiritual crisis. Spiritual

crisis requires spiritual cures.”

Carl Gustav Jung


Holistic Health Focus Supportive Factors Happiness, Meaning & Purpose Internal Trust

INTERNAL TRUSTINTERNAL TRUST

People are currently doing the best they can given their particular circumstances

People have a natural desire and ability (internal wisdom) to be healthy


Holistic Health Focus Supportive Factors Happiness, Meaning & Purpose Internal Trust Professional as Ally

PROFESSIONAL as ALLYPROFESSIONAL as ALLY

Professional facilitates reconnection with people’s own internal wisdom about their body and their life

Goal is to assist people in understanding and healing life issues that underlie illness and behavioral struggles

CHANGING THE ROLECHANGING THE ROLE

“ The field of health promotion needs to revive and reorient its practices toward bringing people together as citizens and community members to decide for themselves the kinds of lives they think are most worth living.”

David Buchanan, An Ethic For Health Promotion


Holistic Health Focus Supportive Factors Happiness, Meaning & Purpose Internal Trust Professional as Ally Cultural Perspective

HEALTH & THE “WEB OF LIFE”HEALTH & THE “WEB OF LIFE”

Nearly 50% of low income, full-time workers have no health insurance

More than 8 million children have no health insurance

25% of children live below the poverty line

US Census Bureau, Oct. 1999

“HOLISTIC” HEALTH PROMOTION

Health Focus Supportive Factors Joy, Meaning & Purpose Internal Wisdom Professional as Ally Cultural Perspective

TRADITIONAL HEALTH PROMOTION

Disease Focus Risk Factors Fear, Guilt & Shame External Control Professional as Expert Individual Focus

Jonathan Robison PhD, Karen Carrier M.Ed., 1999

IMPLICATIONS for HELPING IMPLICATIONS for HELPING & PREVENTING “BURNOUT”& PREVENTING “BURNOUT”

AVOID–Fixing

FIXINGFIXING

“Frequently, our reactiveness to suffering takes the form of having instantly to do something, do anything. It’s the “we gotta” syndrome: “We gotta” fix this up right away…It’s tricky, because this impulse may arise from genuine empathy, but the form of action is compulsive.”

Ram Dass, How Can I Help?

IMPLICATIONS for HELPINGIMPLICATIONS for HELPING & PREVENTING “BURNOUT”& PREVENTING “BURNOUT”

AVOID–Fixing–Reductionism

““MEDICAL TERRORISM”MEDICAL TERRORISM”

“ The important point is that worrying too much about anything--be it calories, salt, cancer or cholesterol--is bad for you, and that living optimistically, with pleasure, zest and commitment is good. Medical terrorism shouldn’t attack life’s pleasures.”

Ornstein & Sobel, Healthy Pleasures


AVOID–Fixing–Reductionism –Blame and Shame

BLAME & SHAMEBLAME & SHAME

personal focus

failure

shame

hopelessness

helplessness

decreased self-esteem

?


AVOID–Fixing–Reductionism –Blame and Shame–Judgment

NONJUDGMENTNONJUDGMENT

“ When we have for so long been judged

by everyone we meet, just to look into

the eyes of another who does not judge

can be extraordinarily healing.”

Dr. Jack Kornfield, A Path With Heart


INSTEAD–Listen

LISTENINGLISTENING

“ Now we can begin, perhaps for the first time, to hear them. Less busy pushing away suffering, less frenzied having to do something about it, we’re able to get a sense of what they’re feeling, of what they feel they need. We may be startled to discover that what they’ve been asking for all along is entirely different from what we’ve been so busy offering”

Ram Dass, How Can I Help?


INSTEAD–Listen–Acknowledge & Validate

Support & Encourage

WHAT REALLY HELPS?WHAT REALLY HELPS?

What We Door

Who We Are


“ We can, of course, help through all

that we do. But at the deepest level we

help through who we are..”

Ram Dass, How Can I Help? `

IMPLICATIONS for HELPING & PREVENTING “BURNOUT”

INSTEAD

• Listen

• Acknowledge & Validate

• Support & Encourage

• Be Aware of Our Own Issues


“We work on ourselves, then, in order

to help others. And we help others as

a vehicle for working on ourselves.”

Ram Dass, How Can I Help? `


“ Placing service in a spiritual perspective in no way diminishes what we have to offer through training, experience, individuality, special skills, or sense of humor. Quite the reverse. Our particular talents and unique qualities are likely to come forth more reliably when we have a richer and more spacious sense of who we are.”

Ram Dass

a holistic model for health & wellness in the workplace

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