VOLUME
T H E
W O R K P L A C E
W E L L N E S S
Holistic Health Promotion helps employees
and practitioners address health behaviors
in a whole new way. In this issue of
Absolute Advantage, we’ll examine Holistic
Health Promotion, exploring the strong
emphasis it places on realizing the interconnectedness of the
mind, body, and spirit in ultimate health. Find out how Holistic
Health Promotion can lead to positive health change by making
the critical link between health, happiness, and finding purpose
and meaning in life.
H
E
W
E
L
L
N
E
S
S
C
O
NUMBER
M A G A Z I N E
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From the Executive Editor
As health promotion continues to firmly entrench itself in
the fabric of corporate America, change is inevitable.
Indeed, at the very time traditional practices and paradigms
are being understood and implemented on a large scale,
new approaches materialize. It’s the nature of our field, it’s
the nature of business, and it’s the nature of life itself.
The emergence of Holistic Health Promotion is one of
those changes, and it promises exciting new avenues for
health and healing at the worksite. Making a profound
departure from the traditional, disease-centered approach,
Holistic Health Promotion offers practitioners and
employees an important new perspective—a vision of
health based in large part on finding pleasure, purpose and
meaning in life, significant spiritual connections, and
strong systems of social support.
In this issue of Absolute Advantage, we’ll uncover the
mystery of Holistic Health Promotion and show you how
it can be incorporated into your worksite. We’ll provide
strategies for overhauling some of your current offerings
and take a look at the Kailo program, widely regarded as
one of the first and best Holistic Health Promotion programs in the country.
We are proud to have worked with this month’s Guest
Editor and Holistic Health Promotion expert, Jon Robison,
PhD, MS, to address this topic. Dr. Robison, and the special authors he has chosen, illuminate Holistic Health
Promotion in a way that will enable health promotion professionals—and the employees participating in their programs—to take hold of new ideas that will lead to better
health, better lives, and better business.
As change continues to occur in our field, we owe it to
ourselves and our organizations to consider the power and
promise of Holistic Health Promotion.
Jon Robison, PhD, MS
David Hunnicutt, PhD
“
Holistic Health Promotion
offers practitioners and employees
an important new perspective
—a vision of health based
in large part on finding pleasure,
purpose, and meaning in life,
significant spiritual connections,
and strong systems
”
of social support.
Enjoy the issue,
David Hunnicutt, PhD
President and Executive Editor
2004 WELLNESS COUNCILS OF AMERICA
©
©2004 Wellness Councils of America. Visit our website at www.welcoa.org.
|
WWW.WELCOA.ORG
WELCOA
TABLE OF CONTENTS
VOLUME 3, NUMBER 7
Toward A
New Science
Holistic Health Promotion connects
T H E
W O R K P L A C E
W E L L N E S S
M A G A Z I N E
the spiritual, biological, psychologi-
Organizational Founder, William Kizer, Sr.
cal, and social dimensions of health
for a true understanding of health
Welcome
and healing. Find out what Holistic
Absolute Advantage is the interactive workplace wellness magazine that helps large and
small employers link health and well-being to business outcomes. Absolute Advantage
arms business leaders and wellness practitioners with leading-edge workplace wellness
information straight from the field’s most respected business and health experts.
With its online component, Absolute Advantage provides the industry’s most current and
accurate information. By logging on to the magazine’s interactive website, you can access
a whole new world of health promotion—including in-depth interviews with national
health promotion experts and insider’s information about industry products.
Health Promotion is all about and
learn why it matters to modern
health promotion professionals.
Subscription Information
For information about subscribing to Absolute Advantage, contact the Wellness Councils
of America at (402) 827-3590 or via e-mail at [email protected].
Ab • sol • ute Ad • van • tage:
When a company can produce more than its competitors—even though they
have the same amount of resources—it has an absolute advantage.
We believe wellness is that advantage.
Executive Editor, David Hunnicutt, PhD
Dr. Hunnicutt is President of the Wellness Councils of America. As a leader in
the field of health promotion, his vision has led to the creation of numerous
publications designed to link health promotion objectives to business outcomes.
Page 2
6
Senior Editor, Mike Perko, PhD
Dr. Perko has significant experience in worksite wellness. Currently an Associate
Professor at the University of North Carolina at Wilmington, Dr. Perko also
serves on WELCOA’s Medical Advisory Board. He has also served as Associate
Director of Good Health Makes $ense, in Birmingham, AL.
Senior Consultant, Joe Leutzinger, PhD
Formerly Director of Health Promotion at Union Pacific Railroad,
Dr. Leutzinger is currently responsible for developing the consulting division
of WELCOA. Dr. Leutzinger works with community health groups, private
employers, and research funders, and also contributes to the publishing,
research, and grant-writing sectors of the organization.
Managing Editor, Brittanie Leffelman, MS
Brittanie is the Director of Operations and manages major writing projects
at WELCOA. With a Master’s Degree in health promotion, she regularly
coordinates national health forums, major grants, and state and local
wellness initiatives.
Incorporating a holistic approach into your program will mean
rethinking (and rebuilding) some of your current offerings. Here’s a
primer in what you’ll need to do and how you’ll need to do it.
| By Jon Robison, PhD, MS
12
16
20
26
32
Information in this publication is carefully reviewed for accuracy. Questions, comments, or ideas are welcome.
Please direct to Dr. David Hunnicutt, Executive Editor, at the address below.
Information may not be reproduced, copied, cited, or circulated in any printed or electronic form without written permission
from the publisher. ©2004 Wellness Councils of America, 9802 Nicholas Street, Suite 315, Omaha, NE 68114; phone (402)827-3590;
fax (402)827-3594; visit our website at www.welcoa.org. All rights reserved. ISSN 1538-0084.
2004 WELLNESS COUNCILS OF AMERICA
©
|
Big Picture Thinking
This month’s Guest Editor Jon Robison, PhD, MS, discusses how you
can prepare yourself to meet the challenges of addressing employee
health holistically. | INTERVIEW with Jon Robison, PhD, MS
38
Going Holistic
If you’re looking for some help in building a Holistic Health
Promotion program, there are several tools and resources at your
disposal. This article will get you started in the right direction.
| By Jon Robison, PhD, MS and Kelly Putnam, MA
Communications Coordinator, Ethan A. Deas
Ethan acts as liaison with the WELCOA Medical Advisory Board, Board of
Directors, and with national media. He is responsible for coordinating
national events and developing communications materials for corporate
partnership initiatives.
Holistic Health, Inc.
Can Holistic Health Promotion really fit within the confines of traditional corporate culture? Will spiritual connections ever be mentioned
in the same breath as yearly financials? It’s time to find out.
| By Walter S. Elias, PhD
Director of Publications, Bo Abresch
With a strong background in writing and corporate communication, Bo manages
the writing and editing process for all major WELCOA publications including
Absolute Advantage magazine. He has co-authored several publications including
Self Care Essentials: A Simple Guide to Managing Your Health Care and Living Well.
The Kailo Concept
Using a non-traditional, holistic wellness program that focuses on
overall wellness, life satisfaction, and job engagement, Mercy Medical
Center - North Iowa has created a program that achieves results.
| By Kelly Putnam, MA
Lead Graphic Designer, Justin Eggspuehler
A 2001 graphic design graduate from Iowa State University, Justin studied
design in Rome, Italy before joining the WELCOA design staff. He is responsible for the layout and design of many publications including The Well Workplace
newsletter and Absolute Advantage magazine.
Seeing Things Through Different Eyes
There’s a real difference between the biomedical and holistic
approaches when it comes to helping employees deal with health
risks. Get a clear perspective on how Holistic Health Promotion differs
from the traditional approach in this article.
| By Karen Carrier, MEd
Creative Director, David Trouba, MA
With over 15 years of experience in magazine, book, and catalog design,
David oversees all publications produced by WELCOA including The Well
Workplace newsletter, Absolute Advantage magazine, brochures, books, and
communications materials.
The Path To Spiritual Wellness
Addressing spirituality in health promotion may seem akin to beating
a bee hive with a stick—you’re liable to get stung. It doesn’t have to
be this way. Stress management programs offer a unique opportunity
to delve into spiritual well-being with trust and openness.
| By Brian Luke Seaward, PhD
Director for Council Affairs, Kelly Stobbe, MEd
As the Director for Council Affairs, Kelly is responsible for leading WELCOA’s
cadre of locally-affiliated wellness Councils. In this capacity, Kelly coordinates
the Well Workplace awards initiative as well as the Well City USA community
health project.
Reinventing The Profession
40
A New Day
So what does the future hold for Holistic Health Promotion?
The answer lies in answering the question, “Is it what we do
or who we are that is the most critical component of helping
people grow and heal?” | By Jon Robison, PhD, MS
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A new model for health promotion focuses on a true understanding
of health and healing, seeking optimal wellness by incorporating
all dimensions of the human experience.
| By Jon Robison, PhD, MS
Toward A New Science
The Way We Were
T
Traditionally, worksite health promotion efforts have focused primarily on attempting to control and/or eliminate risk factors for
disease. Health professionals identify unhealthy habits and try to
motivate employees to replace these habits with healthier ones.
Employees are encouraged to join behavior change programs that
reward them for changing their behaviors, and they are told they
will decrease their chances of contracting certain diseases and
dying prematurely if they do so.
The science behind this approach to health promotion is the
“biomedical model” of health and disease that has its roots in the
Scientific Revolution of the 17th century. As with all of western
science, the biomedical model is based on classical Newtonian
Physics, which portrays the universe and everything in the universe (living and nonliving) as machines that can be understood
only by reducing them to their smallest component parts.
According to this worldview, there are actually two separate universes, one composed of all those things that can be measured and
quantified and one made up of those things that cannot. Only
phenomena that are quantifiable and measurable are seen as valid
and worthy of scientific study.
Within this framework, it is the role of the scientist to disassemble natural phenomenon into their smallest components
(reductionism), analyze them, and put them back together, with
the eventual goal of being able to predict and ultimately control
them. In fact, complete control of nature is seen as the underlying
purpose of science as made clear by Sir Francis Bacon, a major
architect of the 17th century worldview, when he said:
The purpose of science is to torture nature’s secrets from her so she
can be forced out of her natural state and squeezed and molded.1
This mechanistic, reductionist, control-oriented view of reality
remains the cornerstone of current approaches to scientific medicine and also provides the foundation for all human systems in
contemporary society (legal, politics, economics, education, etc.).
Traditional Health Promotion:
Disease Focus, Fear, and Behavioral Control
Given the legacy of this 17th century worldview, it is not at all surprising that traditional approaches to promoting health have
conceptualized the human body as a sophisticated machine, disease
and behavioral struggles as malfunctions of the machine, and the
health professional as the repairperson called in to fix the machine.
(This should really be repairman, as only males were permitted to
be healers in the 17th century. Women who claimed to be healers
were routinely labeled as witches and burned at the stake).
Because only things that are measurable and quantifiable count,
the focus is overwhelmingly on biomedical risk factors for disease
such as blood pressure, cholesterol, weight, and/or measurable
behaviors such as exercise, nutrition, and smoking. Just as with any
other natural phenomenon, the belief is that by addressing these
measurable factors, a person’s health status can be objectively determined and the course of future health can be accurately predicted
and eventually controlled. Despite some recent lip service to mindbody concerns, traditional health promotion programs have placed
considerably less emphasis on more intangible and less easily measured issues such as feelings, emotions, relationships, and spirituality.
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Traditional health promotion has generally assumed that
without proper guidance, people will naturally gravitate toward
unhealthy behaviors. Therefore, the role of the health professional
has been to be the expert who polices peoples’ behaviors and finds
ways to get them to change for their own good. Much as the 17th
century scientist yearned to control and dominate nature, so students in health education are taught in a widely used and highly
regarded textbook:
As Science and Technology advance, the least conquered force of
nature remains the human being and its actions.2
Given this foundation, it is perhaps not surprising that health
promotion has largely focused on the use of fear tactics accompanied by incentives, competitions, and rewards to attempt to
control peoples’ behaviors. As the writers of the above mentioned
textbook put it:
From Chaos theory, a more recent outgrowth of physics, we are
also learning that, in fact, human beings are complex systems that
are not amenable to quantification, prediction, and control.7
Therefore for health professionals, working with humans is much
more like trying to predict and control the weather (another
complex system) than it is like assembling and disassembling some
predictable machine. And we all know how accurate weather prediction is! Anyone who works in the health fields has experienced
this lack of controlability and predictability that seems to be an
inherent part of the natural world and of the human experience.
Holistic Health Promotion: Redefining Health
This approach is certainly not meant to be mean-spirited.
However, the legacy of the 17th century paradigm—the intent to
control—is clearly evident, and is often stated quite frankly as when
a leader in the field says about the use of incentives that they can:
Despite being called health promotion, our profession has
remained largely rooted in the biomedical disease-focused paradigm. In Holistic Health Promotion the shift in focus emanates
from a new conceptualization of health. We learned from
quantum physics that it is the relationship between subatomic particles that gives meaning to their existence. Similarly, in Holistic
Health Promotion we emphasize that it is the relationships among
the spiritual, biological, psychological, and social dimensions of
the human experience that are critical to a true understanding of
health and healing. Therefore, rather than defining health in terms
of the absence of biomedical risk factors for disease or the accumulation of some ideal list of healthy behaviors, we believe that:
Jar the attention of someone in precontemplation and force them to
at least think about improving their health.3
Health can be redefined as the manner in which we live well despite
our inescapable illnesses, disabilities, and trauma.8
The New Sciences
Traditionally, even when health is defined as more than just the
absence or opposite of disease, it is still most often described as
The central concern of health promotion and health education is
health behavior…how to bring about change…[and] developing
techniques that change behavior.2
As a result of profound scientific discoveries in the last century,
this 400-year-old view of the universe and, along with it, our
understanding of health and illness, has changed dramatically.
Findings in physics, psychoneuroimmunology (PNI), chaos and
complexity, and consciousness research are pointing humanity
toward a more holistic view of the universe and drastically altering
our conceptions about why people get ill and how they heal.
Figure 1 contrasts the new scientific assumptions with those of the
17th century worldview.
Thanks to the relatively new science of PNI we now understand
that human beings are much more than just an assortment of
mechanical parts forming a sophisticated machine. This research
shows that unlike machines, humans have personalities, thoughts,
feelings, and emotions, all of which can powerfully impact our
immune system and affect our resistance to illness and our ability
to heal.4 Furthermore, recent related findings in consciousness
research demonstrate that, contrary to the assumptions of the old
science, the human mind is a powerful tool for self healing and
may even be used to assist in the healing of others.5
This new view of human health fits well with discoveries in the
hardest of the sciences, ironically the same scientific discipline that
gave us the mechanistic worldview some 400 years ago. Indeed,
today from quantum physics we learn that the universe is not
composed of tiny separate building blocks, but is rather a vast
interconnected web whose component parts are impossible to
accurately isolate and quantify because their existence is really only
understandable in the context of their relationship to each other.
It is therefore unlikely to be a coincidence that a growing body of
research also supports that the web of relationships that we engage
in as human beings may be a crucial factor, if not the crucial factor
in determining our health and our own ability to heal.6
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ABSOLUTE ADVANTAGE
Figure 1
Comparing Scientific Assumptions
THE OLD SCIENCE:
Mechanistic: humans are sophisticated machines
Reductionistic: the whole is equal to the sum of its
parts
Dualistic: matter and spirit are separate—only things
that can be measured make a difference and should
be studied
Patriarchal: masculine values (competition, control,
and aggression) predominate
THE NEW SCIENCE:
Organic: humans are living, complex systems
Holistic: the whole is greater than the sum of its parts
Interconnected: social, emotional, and spiritual, as
well as physical factors, are important to health and
worthy of scientific study
Egalitarian: feminine values (nurturance, compassion,
trust) considered to be of equal importance
Compared to old science, new scientific discoveries
suggest that we view health promotion in a new light.
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©2004 Wellness Councils of America. Visit our website at www.welcoa.org.
WELCOA
some optimal state of well-being that can be achieved if we just try
hard enough. The World Health Organization, for example,
defines health as “a state of complete physical, mental, and social
well-being.” A trip to the local bookstore will reveal a seemingly
endless supply of books by health experts that claim to provide the
steps needed to reach this proposed state of optimal health. The
problem is, of course, that as human beings, we all live with
varying amounts of physical, psychological, and spiritual baggage.
How many people have ever experienced or ever known anyone in
optimal health? What does that mean? As medical writer David B.
Morris suggests in his insightful book, Illness and Culture in the
Postmodern Age:
Figure 2
Health Promotion:
Shifting The Focus
Biomedical Focus
Holistic Focus
Risk Factors For Disease
Supportive Factors For Health
Blood Pressure
Purpose in Life
Total Cholesterol
Spiritual Connections
HDL Cholesterol
Social Support
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.8
LDL Cholesterol
Meaning in Work (paid/unpaid)
Total Cholesterol/
HDL Ratio
Ability to
Experience Emotions
It is more than likely that we will all struggle with emotional,
spiritual, and physical issues during our lifetimes, and it is
inevitable that we will die. Understanding and living skillfully and
compassionately with these struggles, rather that perpetually
searching for the latest holy grail of optimal health, may come
closer to what it truly means to be healthy.
The critical point in understanding health from a holistic perspective is that health really has to do with the manner in which we
deal with what we are given in life. The concept of health therefore
becomes much less black and white, a complex and dynamic dance
that is not easily quantified, controlled, or predicted. The emerging research compels us to broaden our focus to consider a wide
range of psychological, social, and spiritual factors that appear to
have as much if not more influence on our health than the more
traditional biomedical risk factors for disease. These supportive
factors for health are listed alongside the traditional risk factors for
disease in Figure 2. 9 As we will see in the following article, Reinventing The Profession, this shift in our conceptualization has
tremendous ramifications for health promotion and for our roles as
health professionals.
Triglycerides
Ability to Express Emotions
ABOUT: Jon Robison, PhD, MS
Jonathan Robison holds a doctorate in health
education/exercise physiology and a master of science in
human nutrition from Michigan State University where he is
adjunct assistant professor. Dr. Robison speaks frequently at
national conferences and has published numerous scientific
articles on a variety of health-related topics. His work promotes shifting health promotion away from its traditional,
biomedical, control-oriented focus. He is also involved
nationally with the Health At Every Size movement and has
been helping people with weight-related concerns for more
than 15 years. Aside from his work, Dr. Robison’s passions
include his wife Jerilyn, his 9-year-old son Joshua, music,
humor, and raquetball. Jon can be reached by emailing him
at [email protected].
All information © Wellness Councils of America (WELCOA) 2004.
WELCOA provides worksite wellness products, services, and information to
thousands of organizations nationwide. For more information visit
www.welcoa.org.
Suggested Citation: Robison, J. (2004). Toward A New Science. WELCOA’s Absolute
Advantage Magazine, 3(7), 2-5.
Smoking
Drinking
Cardiovascular Fitness
Abdominal Strength
Upper Body Strength
Flexibility
Back Care
Weight
Fat Intake
Sodium Intake
Optimism and Hopefulness
Perceived Happiness
Perceived Health
Intellectual Stimulation
Restful Sleep
Time Alone
Pleasure and Play
Financial Resources
Laughter and Humor
Movement/Physical Resilience
Sugar Intake
Abundant/Varied
Food Supply
Fiber Intake
Contact with Nature
The shifting focus of health promotion means more emphasis
can be placed on the supportive factors for health, not just the
risk factors for disease.
References
1. Capra, F. The Turning Point: Science, Society, and the Rising Culture. Toronto:
Bantam, 1983.
2. Glanz K., F. Lewis, and B. Rimer. Health Behavior and Health Education: Theory,
Research, and Practice. 2d ed. San Francisco: Jossey-Bass, 1997.
3. O’Donnell, M. P. Characteristics of the Best Workplace Health Promotion Programs. Wellness Management: Newsletter of the National Wellness Association
(summer 1997).
4. Pert, Candace B. Molecules of Emotion: Why You Feel the Way You Feel. New York:
Scribner, 1997.
5. Dossey, Larry. Reinventing Medicine: Beyond Mind-Body To A New Era of Healing.
San Francisco, Harper, 1999.
6. Ornish D. Love and Survival: The Scientific Basis for the Healing Power of Intimacy. New York: HarperCollins, 1998.
7. Briggs J., and D. Peat. Seven Life Lessons of Chaos: Spiritual Wisdom from the
Science of Change. New York: Harper Perennial, 1999.
8. Morris DB. Illness and Culture in The Postmodern Age. University of California
Press, Berkeley, 1998.
9. Robison J, Carrier K. The Spirit and Science of Holistic Health: more than broccoli, jogging and bottled water, more than yoga, herbs and meditation.
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©2004 Wellness Councils of America. Visit our website at www.welcoa.org.
ABSOLUTE ADVANTAGE
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Reinventing The
Profession
Holistic health
promotion provides
wellness professionals
with an opportunity to
support people’s health and human
needs in a more compassionate and
effective way. Find out how to help
employees explore the interconnectedness
of their health issues and behavioral challenges
within the larger context of their lives.
| By Jon Robison, PhD, MS
6 |
ABSOLUTE ADVANTAGE
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©2004 Wellness Councils of America. Visit our website at www.welcoa.org.
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2004 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG
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©2004 Wellness Councils of America. Visit our website at www.welcoa.org.
ABSOLUTE ADVANTAGE
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A
As we move from a biomedical, mechanistic view of health and healing to a more
holistic “quantum” view, it is important
for worksite health practitioners to rethink
their professional goals and roles as well as
the design of traditional health promotion
programs. The major foundations of the
traditional health promotion model are
contrasted with those of Holistic Health
Promotion in Figure 1 to the right.1
In Holistic Health Promotion, the
emphasis in both assessment and intervention shifts from risk factors for disease to
what we have termed “supportive factors
for health.” This emphasis on supportive
factors is underscored by the belief that for
most people, meaning in life, relationships, and the supportive quality of
human systems are the primary determinants of health status. Traditionally, most
of our efforts in health promotion have
been directed toward addressing the
“unhealthy behaviors” that people are
using to cope with their emotional pain.
Rarely do we go below the surface to
address the suffering that spawns these
behaviors. Even less often do we take the
time and effort to help people explore and
resolve the fundamental roots of their suffering, the actual underlying causes of
most unhealthy behavior—poverty, abuse,
isolation, social oppression, etc. Without
addressing these issues, we may temporarily alter the overt behaviors in question,
but we are unlikely to affect long-term,
positive behavior change. (See Figure 2).1
We believe that this shift in our understanding can provide invaluable insight
into many of the weaknesses of traditional
approaches to worksite health promotion.
For example, traditional health risk assessments, which have been a cornerstone of
worksite programs, only poorly predict
medical costs at the workplace. We now
know that this is because their focus on
biomedical risk factors does not accurately
identify the pareto group, the relatively
small proportion of the population that
typically incurs the majority of healthcare
costs. As it turns out, these people are
better identified using more psychosocially-oriented evaluations. Indeed, recent
studies show that the factors accounting
for the largest proportion of medical costs
at the workplace are not blood pressure,
cholesterol, and heart disease, but less
measurable and quantifiable factors related
to stress and depression.2
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Figure 1
Comparison Of Health Promotion Approaches
Traditional
Focus
Emphasis
Motivation
Primary
Assumption
Professional
Role
Change
Process
Holistic
Disease: Main objective
is to identify and eliminate biomedical risk
factors for physical
disease.
Health: Main objective is
to address the interconnected web of genetic,
social, emotional, spiritual, and physical factors
that contribute to health.
“Unhealthy” Behaviors:
Poor individual lifestyle
choices are considered
the primary determinants
of sickness and disease.
Meaning and Support:
Meaning in life, relationships, work, and
supportive human systems
are considered the primary
determinants of health.
Fear: Reason for change
is primarily to prevent
disease and premature
death.
Happiness: Reason for
change is primarily to
enhance a sense of
purpose and enjoyment
of life.
People are Bad: Left to
their own devices, people
will naturally gravitate
toward “unhealthy”
behaviors.
People are Good: People
have a natural desire and
ability to seek out healthy
behaviors.
Expert: Primary job is to
police behaviors and prescribe changes to save
people from themselves.
Ally: Primary job is to
facilitate peoples’ reconnection with their own
internal wisdom about
their body and their life.
Controlling Behavior:
Behavior change techniques are used to
suppress or eliminate
targeted behaviors.
Creating Consciousness: People are assisted
in understanding and
healing life issues that
underlie illness and
behavioral struggles.
Holistic Health Promotion and the traditional biomedical approach view health
and healing from very different perspectives.
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This is certainly not to suggest ignoring the
dangers of biomedical risk factors such as
elevated blood pressure and high cholesterol or behavioral problems such as drug
abuse and compulsive eating. However,
from a holistic perspective we understand
that these issues are more often than not
symptomatic of underlying emotional distress and that healing can best be facilitated
by helping people to address them within
the larger context of their lives. For
example, medical claims for back problems
at the workplace are notoriously high. Such
back pain is difficult to treat and standard
interventions that focus on weight loss,
exercise, and proper lifting are often not
successful. Interestingly, research suggests
that the single best predictor of medical
claims for back pain at the workplace is not
weight, fitness, or proper lifting technique,
but rather worker satisfaction; specifically,
how workers feel about their supervisor.3
Re-Examining
The Reasons For Change
In Holistic Health Promotion, the primary
reason for change shifts from the fear of
death and disease to a desire to enhance a
sense of purpose and enjoyment in life. The
use of fear, guilt, and shame as “motivators”
is seen as unproductive and inhumane.
(After all, if fear were a good motivator,
everyone in this country would certainly be
thin and exercising!). People are not blamed
for eating the wrong foods, being sedentary,
or not meditating. It is understood that in
the final analysis, who gets sick and who
stays healthy is the result of an infinite
number of interacting variables, many of
which will never be known for any particular individual. From a holistic perspective
then, the reason for change has more to do
with enhancing how people feel about
themselves and the meaning of their lives
than with reducing the statistical probability
that they will contract this or that disease
and die prematurely.
One of the major implications of this
holistic perspective on promoting health is
a switch to using joy and pleasure rather
than fear as “motivators.” This makes a
great deal of practical sense even from a
purely “behavioral” point of view. Think
of something that you love to do. It could
be almost anything from hiking to
cooking, to playing a sport, to knitting.
Often when you are engaged in this activity, you are completely absorbed and time
seems to stand still. This is a state of being
that scientists call “flow.” It feels wonderful and is associated with healthful
biochemical changes in the body.4 When
something is this enjoyable, it is easier to
sustain over time.
The “secret” from a holistic perspective
is that people do not need external motivation (incentives, competitions, and
rewards) to “get” them to do something
they love! Although traditional health promotion continues to sing the praises of
rewards and incentives, there is scant evidence that their use results in long-term
change.5 In fact, a significant body of
research demonstrates that attempting to
bribe or coerce people to change, even with
“positive” pressure, does not usually result
in long-term change and can actually cause
more problems than it solves.6,7 In Holistic
Health Promotion our desire is to help
people find joy—to find what it is that
puts them into a state of flow, and that
helps them to feel that their lives have
meaning and purpose. Once they find
these things, they will not need our water
bottles and T-shirts to ensure maintenance!
Professional Roles And Goals
Traditional approaches to health promotion assume that people naturally gravitate
toward unhealthy behaviors. Therefore the
primary focus has been on developing
strategies and techniques to secure compliance or adherence to “get” people to
change their unhealthy behaviors to save
them from themselves. In Holistic Health
Promotion, however, we assume that
Figure 2
The Roots Of “Unhealthy” Behavior
Behavioral Coping
Disease
Smoking, Drinking, Drugs, Overeating, Overworking, Sedentary Lifestyle,
Gambling, Chronic Dieting, Exercise Addiction, Sex Addiction,
Compulsive Shopping
Diabetes
Cancer
Hypertension
AIDS
Suffering
Disease
Heart Disease
Stroke
Lipid Abnormalities
Infectious Disease
Anxiety, Anger, Fear, Depression, Hopelessness
Root Causes Of Behavior
Poverty, Abuse, Violence, Isolation, Social Oppression
Assisting people in exploring the underlying root causes of behavior that lead to suffering, behavioral coping,
and disease, is the main focus of Holistic Health Promotion.
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ABSOLUTE ADVANTAGE
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people are currently doing the best they
can given their particular circumstances
and that they have the natural desire and
ability (internal wisdom, if you will) to be
healthy. If they are behaving in ways that
are unhealthful or hurtful to themselves or
others, it is because they are experiencing
distress, which makes it difficult for them
to act in ways that make more sense.
This change in perspective is profound
and often understandably scary for those
of us who were traditionally trained. In
Holistic Health Promotion, the goal is no
longer to get people to do any particular
thing, but rather to assist them in understanding and healing the life issues that
underlie their illness and behavioral struggles. Thus, the role of the health promoter
changes drastically from that of expert
police—identifying and eliminating
unhealthful behaviors—to compassionate
ally—helping people uncover barriers that
prevent them from accessing their own
internal wisdom about what a healthy life
means for them.
Accordingly, the most important tools
for practitioners in the field shift from
behavior change strategies to listening skills,
compassion, and the ability to make a
human connection. Again, this can be
unnerving for health professionals who
have been traditionally trained. Talking to
people about health problems in relation to
social oppression, isolation, childhood
trauma, job satisfaction, and purpose in life
may seem beyond the reach of those trained
in only biomedical approaches; more
appropriate for licensed psychologists and
counselors. Yet, health promotion professionals can learn to use these types of tools
without inappropriately crossing into the
realm of clinical psychotherapy or treatment. We may not be licensed therapists,
but we are all licensed human beings! All of
us can provide a safe space and respectful
listening, perhaps the two most powerful
healing tools we can offer another person.
A Spiritual Endeavor
Perhaps at this point you are beginning to
think that helping people in this way
sounds a lot like spiritual work. This is a
critically important concept. From a holistic perspective, whether the presenting
problem concerns exercise, nutrition,
weight, smoking, depression, stress, etc.,
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Figure 3
Comparison Of Health Promotion Approaches
Traditional
Holistic Modification
Life Center: Soften the emphasis
on physical health, cardiovascular
conditioning, and strength training.
Create a resource/support center
that helps people explore a broad
range of life issues (relationships,
financial wellness, rest and play,
aging, mind/body healing, spirituality, etc.).
Fitness Facility
Exercise Classes
Movement Offerings: Create
experiences for exploration of
the mind-body-spirit connection
through movement. Move away
from connecting movement with
reshaping the body, losing weight,
and compensating for overeating.
Weight Control/Nutrition
Body Image/Eating Behavior:
Help people regain a normal relationship with food by addressing
chronic dieting, body dissatisfaction, and cultural weight prejudice.
Stress Management
Life Simplification/Enhancement:
Move away from the emphasis on
controlling symptoms of stress.
Help people to address the origins
of stress and understand the relationship between life struggles and
the development of illness and pain.
Competitions/Incentives
Eliminate These Whenever Possible: If this is not possible, sponsor
individual promotions rather than
group competitions, reward behaviors and not outcomes, and provide
incentives that encourage individuals to explore a broad range of
behaviors and accomplishments.
In Holistic Health Promotion, many of the traditional approaches are
modified to emphasize the interconnected nature of true health and healing.
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“The key is to understand that it is not
our job to decide
for [people] but to
help them learn to
access their own
wisdom so that they
can decide for themselves what the
healthy or good life
really means.”
health promotion is fundamentally about
helping people find happiness, meaning,
and purpose in life—clearly a spiritual
endeavor. The great humanistic psychologist Carl Jung understood this when he
said “Every crisis a person has over the age
of thirty is a spiritual crisis. Spiritual crisis
requires spiritual cures.”
In Holistic Health Promotion therefore,
behavior change is no longer the primary
focus of intervention or the primary role
of the health professional. Rather than
decide for people what they should or
should not do, the object now is to help
people understand their health behaviors
within the larger context of their lives.
This does not mean that health professionals should refuse to provide people
with information. It does mean that we
understand that the meaning people
attach to information is something that
should not and cannot be controlled from
the outside. We can tell people that having
elevated cholesterol increases the statistical
probability of having a heart attack by a
certain percentage, but we cannot make
the judgment for them as to whether it is
worth it to give up their usual patterns of
eating in order to reduce the probability
by that percentage. The key is to understand that it is not our job to decide for
them but to help them learn to access their
own wisdom so that they can decide for
themselves what the healthy or good life
really means.8
Holistic Programming
Reinventing health promotion will involve
re-examining all aspects of traditional programming. Fitness centers, health fairs,
brown-bag sessions, and many other standard areas of wellness programming need
to be revised to reflect more holistic concepts. New programs that acknowledge
the vital interconnectedness of relationships, work, and community issues in
relation to health, also need to be developed. Furthermore, we must make sure
that the images, language, and artwork
used in marketing pieces and educational
programs also reflect the new holistic
information and themes. (Figure 3 on the
previous page presents some ideas for
modifying traditional programs.)1
Holistic Health Promotion provides
health professionals with an opportunity
to support people’s health and human
needs in a more compassionate and effective way. Instead of focusing on
controlling isolated symptomatic illnesses
or behaviors, we can help people explore
the interconnectedness of their health
issues and behavioral challenges within the
larger context of their lives. Our clients
and program participants then have a
unique opportunity to heal their symptoms while also developing a deeper
understanding of the underlying life struggles that these symptoms represent. In the
remaining articles in this issue, we will
explore the powerful implications and
exciting practical applications of this new
approach to worksite health promotion.
References
1. Robison J, Carrier K. The Spirit and Science
of Holistic Health: more than broccoli,
jogging and bottled water, more than yoga,
herbs and meditation.
2. Goetzel, R.Z., D.R. Anderson, R.W. Whitmer,
R.J. Ozminkowski, R.L. Dunn, and J.
Wasserman. The Relationship between
Modifiable Health Risks and Health Care
Expenditures. Journal of Occupational and
Environmental Medicine 40, no. 1 (1998):
843–54.
3. Bigos SJ, Battie MC, Spengler DM, Fisher
LD, Fordyce WE, Hansson TH, Nachemson
AL, Wortley MD. A Prospective Study of
Work Perceptions and Psychosocial Factors
Affecting the Report of Back Injury. Spine
1991 Jun;16(6):688.
4. Csikszentmihalyi, M. Flow: The Psychology
of Optimal Experience. New York: HarperCollins, 1991.
5. O’Donnell, M.P., C.A. Bishop, and K.L.
Kaplan. Benchmarking Best Practices in
Workplace Health Promotion. American
Journal of Health Promotion: The Art of
Health Promotion 1, no. 1 (1997;): 1–8.
6. Kohn, A. Punished by Rewards: The Trouble
with Gold Stars, Incentive Plans, A’s, Praise,
and Other Bribes. Boston: Houghton Mifflin,
1993.
7. Robison, J.I. Questioning the Wisdom of
Using External Reinforcement in Health
Promotion Programs. American Journal of
Health Promotion 13, no. 1 (1998): 1–3.
8. Greenberg, J. S. Health Education: LearnerCentered Instructional Strategies. 4th ed.
Dubuque: William C. Brown, 1998.
All information © Wellness Councils
of America (WELCOA) 2004.
WELCOA provides worksite wellness products, services, and information to thousands
of organizations nationwide. For more information visit
www.welcoa.org.
Suggested Citation: Robison, J. (2004). Reinventing The
Profession. WELCOA’s Absolute Advantage Magazine,
3(7), 6-11.
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| By Brian Luke Seaward, PhD
Ageless Wisdom For These Uncertain Times
In 1981, I had the great honor of meeting Elisabeth
Kübler-Ross, MD, a pioneer in the field of holistic medicine. She was the keynote speaker for the American
Holistic Medical Association’s annual conference in La
Crosse, Wisconsin. Although she had earned an international reputation in the field of thanatology (the study of
death and the psychological mechanisms for dealing
with it) with her acclaimed book, On Death and Dying,
on this day her keynote presentation addressed the topic
of holistic wellness. “Health,” she said, “is derived from
the Anglican word “Hal,” meaning to be whole or holy.
Every time you use the word “health,” whether you
realize it or not, you are inferring some sense of human
spirituality.”
She went on to say that, although the word wellness
is new to the American vernacular, the concept is considered ageless wisdom; it has been around for
thousands of years. The wellness paradigm (mind, body,
spirit, and emotions) is based on the concept that the
whole is greater than the sum of the parts. Drawing a
circle (the universal symbol of wholeness) on a flip chart
with four equal quarters, Kübler-Ross then proceeded
to describe the four components of wellness. When she
got to spiritual well-being, she paused and said, “It’s a
shame that this aspect has received the least attention, as
this is the cornerstone of the wellness paradigm. Spirituality is our very essence. When this aspect of life is
ignored or neglected, it leads to dysfunction at every
level.”1 As it turns out, her words in 1981 have become
quite prophetic with regard to the health promotion
industry in 2004. Today, the word dysfunction is our
national adjective.
From every culture in the global village, the words
“spirit” and “breath” are synonymous, conveying a
sense of flow or energy, or what is commonly known in
the eastern culture as the universal life force. Because of
its inclusive nature, human spirituality is very difficult
to define. The World Health Organization (WHO)
states that “Spirituality is that which is in total
harmony with the perceptual and non-perceptual environment.” The WHO adds this statement as well:
“The existing definition of health should include the
spiritual aspect, and healthcare should be in the hands
of those who are fully aware of and sympathetic to the
spiritual dimension.”2
I
Stress and human
spirituality are partners
in the walk of life.
Stress management
programs at the worksite
offer a unique opportunity
to share ageless wisdom
and help employees pursue . . .
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ABSOLUTE ADVANTAGE
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Relationships, Values, And Purpose In Life
Stress And Human Spirituality
If you were to converse with the shamans, healers, mystics, and
sages of every age and ask them to explain the concept of human
spirituality, you would find three aspects mentioned every time,
regardless of language, culture, or faith. These aspects, relationships, values, and a meaningful purpose in life, are known as the
pillars of human spirituality. Each component intertwines through
every personal circumstance and life event for the sole purpose of
leading us toward a higher level of consciousness, specifically
regarding our connection to the divine, however we define this to
be. Every issue, problem, and concern that we encounter involves
one or more of these aspects. Moreover, relationships, values and
life purpose are the core issues that corporations deal with in terms
of mission statements, strategic planning, benefit packages, labor
relations, etc. On a personal level, these are the aspects we deal
with on a daily basis in terms of family, co-workers, clients, career
goals, retirement, and much, much more.
If there is a language of human spirituality, perhaps it is best
represented through metaphor, simile, and allegory. One
metaphor that appears to be quite common among all cultures is
the concept of a journey or path. As the expression goes, “the spiritual path cannot be measured in miles, years, possessions, or
experiences.” There are some who say it cannot be measured at
all. There are others who say that the length of the spiritual path
is between 12 and 16 inches; the distance from your head to your
heart! The same wisdom keepers and sages who cultivate this
ageless wisdom speak of the importance of love. Love in all of its
great many manifestations—from compassion and humor to
patience and forgiveness—is not only the destination but the
journey of life itself.
The metaphor of a path or journey has a few other characteristics, specifically the roadblocks and distractions that one
encounters while on “the path.” Roadblocks are best described as
life’s major obstacles (stressors) that upon first encounter we would
rather run in the opposite direction from than face head-on and
resolve. While some obstructions can merely be sidestepped, most
demand our immediate attention and resolution. At the worksite,
roadblocks take the form of corporate mergers, restructuring, the
employee from hell, relocations, incompetent managers, excessive
hours, and so on. Compounding these problems are personal
issues (e.g., unruly teenagers, an ex-spouse, financial concerns,
etc.) that bleed into our working hours. The results can and do
make one feel helpless at times.
Distractions on the spiritual path often begin as attractions.
While stopping to smell the roses or enjoy the vistas is certainly
encouraged, the problem begins when the momentary rest period
becomes a permanent residence. This hazard is often referred to
as “falling asleep on the spiritual path.” Our most common distractions are our biggest health issues: the addictions of
alcoholism, narcotics, sex, and gambling, to name a few. Television watching, cell phones, and time on the Internet are our
newest social addictions. Most addiction support groups, based
on the 12-step principles, acknowledge spiritual well-being as a
significant construct of healing. It is interesting to note that rehabilitation programs based on the biomedical model have a much
lower success rate than programs that incorporate the spiritual
dimension in the healing process.
A quick review of the topic of human spirituality from all cultures
of the globe brings one in direct contact with the issue of ego, and
the goal to transcend (or at least domesticate) the ego. A refresher
course in stress management reminds one that where there is ego,
there is stress! The fight or flight response is elicited by either anger
(fight) or fear (flight)—to get out of harm’s way. Although neither
emotion is bad (actually they are both considered healthy as survival emotions), left unresolved they can lead to problems at the
physical, emotional, mental, and spiritual levels of well-being.
There are many definitions of stress; however, the one that I find
most accurate in this regard is: “Stress is a ‘perceived’ disconnection from our divine source.” The word “perceived” is operative
because in truth, we are never separated from our divine source.
However, if issues of anger and fear are left unresolved, moments
of stress (from “bad hair days” to “the week from hell”) can certainly feel like “divine abandonment.”
While they may at first appear to be unrelated, stress and human
spirituality are really partners in the dance of life. Every stressor,
problem, issue, or concern falls directly into the categories of relationships, values (or value conflicts), and a meaningful purpose in
life. As the wisdom of the ages suggests time and again, stress provides the opportunity for spiritual growth—if we take the time to
learn from the experience.3
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Stress Management
And Spirituality At The Worksite
From my experience designing and conducting corporate wellness
programs in the area of spiritual well-being, stress management
classes have proved to be not only a platform, but an open door
through which to present these concepts, all within the conceptual framework of holistic wellness: the integration, balance and
harmony of mind, body, spirit, and emotions. Interestingly, what
began as a “backdoor approach” through stress management
classes more than two decades ago, today has become a gateway to
conduct actual classes and course offerings on spirituality.
With a strong foundation of integrity established, stress management lectures can evolve into programs on spiritual well-being.
It is crucial to keep in mind, however, that anyone conducting
classes related to spiritual well-being must know the company
culture and climate. They must also be “multilingual” in the delivery of the content, so as to reach as many people as possible in a
non-threatening way. Words such as “meditation” might be
acceptable at one worksite and not at another. (The words “reflection” and “centering” are often used for meditation).
To show how much times have changed, the Fishell Company
of Columbus, Ohio shifted the focus of their annual two-day
meeting in February 2000 from administrative and technical presentations to the topic of spiritual health. Jeff Keeler, President and
CEO of Fishell, inferred the time was right by saying, “We took a
big risk, and it was worth it. The results exceeded all expectations.”
From Theory To Application: The Next Step
In these uncertain times of rapid change and global terrorism, people
are searching for meaning and purpose in their lives. The expression
“spiritual hunger” has become all too common in every aspect of
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“As the wisdom of the ages
2) Joan Cantwell, former Director of the Quaker Oats wellness
program in Chicago, IL, conducted an on-going class in Mindfulness Meditation (based on Jon Kabot-Zinn’s program) with
overwhelming success.
provides the opportunity for
3) Kelly Putnam, the Director of the Kailo Employee Wellness
Program at Mercy Hospital in Mason City, IA has coordinated
seminars in Stress and Human Spirituality, “Spiritual Appetizer”
breaks (visualizations, meditations, and back-to-nature programs),
and “Kailo for One” sessions (one-on-one sessions with a staff
social worker trained in mind-body-spirit dynamics).
spiritual growth—if we take the
4. Hunton and Williams, a law firm in Washington, DC ran a
series of successful complementary medicine expos designed to
expose the staff to mind-body-spirit integrative health modalities.
suggests time and again, stress
time to learn from the experience.”
society, specifically at the worksite because people spend so much
time there. This issue again comes to light with the ethical scandals
within corporations such as Enron, MCI, and Tyco.
With the understanding that there is no division between mind,
body, spirit, and emotions, it is fair to say that the concept of
human spirituality is already present in corporate wellness programming. The implementation of ideas, concepts, and
application of spiritual well-being is typically more subtle than
dynamic with regard to the wellness construct. By this I mean that
for spiritual well-being programs to be effective or successful, they
need not try to replicate the Disney World epiphany effect. Hatha
yoga, meditation, and Tai Chi classes not withstanding, many
classes, courses, presentations, and workshops can be offered at the
worksite which incorporate the aspects of relationships, values and
meaning in life, roadblocks and distractions, and the health of the
human spirit.4 Moreover, by moving from a tacit recognition to
fully honoring spiritual well-being, the true promise of the wellness paradigm is fulfilled with the whole being greater than the
sum of the parts. Following are some additional examples of
organizations that have incorporated programs honoring the spiritual dimension of wellness.
Walking The Talk
1) At the United States Postal Service Headquarters wellness
program, the following series was offered, with great success: 5
• A lecture series on Roadblocks on the Human Path including Creative Anger Management, Prolonged Grieving, and
the Art of Forgiveness.
• A workshop series on inner resources, including humor
therapy, imagination and creativity, self-esteem, and
patience.
• A journal-writing class where participants explored a series
of soul-searching themes including values and values clarification, embracing the shadow (ego), unwritten letters
(resolution processes), and sweet forgiveness.
5. Conoco Oil in Houston, TX continues to offer a balance of
mind-body-spirit programs as well as various theme days including “Random Acts of Kindness Day,” “Attitude of Gratitude Day,”
“Earth Day,” “An Ounce of Patience Day,” and “Serenity Day”
(based on the Serenity Prayer).
Times of change and uncertainty, like those of today, are the
hallmark of personal stress. Moreover, times of stress only add to
the hunger of the human spirit for wholeness. Ageless wisdom
reminds us that spiritual well-being is indeed the foundation upon
which all other aspects of wellness rest. To ignore or neglect the
health of the human spirit leaves the true meaning of health
incomplete. Stress management programs offer a unique opening
with which to share the ageless wisdom of spiritual well-being.
ABOUT: Brian Luke Seaward, PhD
Brian Luke Seaward, PhD is a faculty member of the University of Northern Colorado and the Executive Director of
Inspiration Unlimited. He is the author of several books
including Stand Like Mountain, Flow Like Water, and Stressed
Is Desserts Spelled Backward. He can be reached at www.brianlukeseaward.net
References
1. Kubler-Ross, E., Keynote Address, American Holistic Medical Association conference, LaCrosse Wisconsin, 1981.
2. As quoted in Christian News Notes, New York, NY. 1991.
3. Seaward, B.L., Health of the Human Spirit. Allan & Bacon, Boston.
2001.
4. Seaward, B.L., Stand Like Mountain, Flow Like Water: Reflections on
Stress and Human Spirituality. Health Communcations Inc. Deerfield
Beach, FL. 1997.
5. Seaward, B. L., Meholick, B., and Campanelli, L., Introducing the
Spiritual Well-being Component into Corporate Health Promotion Programming. Wellness Perspectives, 8: 16-30, 1992.
All information © Wellness Councils of America (WELCOA) 2004.
WELCOA provides worksite wellness products, services, and information to
thousands of organizations nationwide. For more information visit
www.welcoa.org.
Suggested Citation: Seaward, Brian L. (2004). The Path To Spiritual Wellness. WELCOA’s
Absolute Advantage Magazine, 3(7), 12-15.
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Seeing Things Through Different
Holistic Health Promotion clarifies wellness strategies, allowing us to view health
from a whole-person point of view. | By Karen Carrier, MEd
C
Contrasting the underlying beliefs of the
traditional biomedical model with newer,
more holistic approaches illustrates just
how dramatically we might change our
style of working with people if we want to
truly foster the process of healing. An
excellent way to get a feel for this shift in
approach is to think about how an actual
person is treated differently in a biomedical program versus a more holistic one.
The following case study illustrates how an
actual client might be viewed and supported differently in the traditional versus the
holistic approach.
This case study provides information
about a woman who was referred to a wellness program by her private physician. She
was experiencing health problems, and her
doctor thought participation in a wellness
program might be beneficial. Let’s look at
the information provided by her physician
at the time of referral, and the kind of
health recommendations that would likely
have resulted using a traditional biomedical approach. Then, in comparison, let’s
take a holistic view of her situation and see
how it changes the way we would seek to
support her.
Seeing Marsha
Through Biomedical Eyes
Medical History. “Marsha” is a thirty-nineyear-old African-heritage female. She
initially went to her doctor because she was
experiencing frequent headaches. After
ruling out physical causes for the headaches,
her physician suspected that they were stress
related and suggested exercise, dietary
changes, and stress-management information. Additional biomedical information
about Marsha provided by her physician
included the following.
• She is 5 feet, 3 inches tall and
weighs 243 pounds
• Her only reported significant
illness or surgery in recent years
was a partial hysterectomy
(removal of her uterus only) at
age thirty-seven due to fibroids
• Her blood pressure is currently
165/92
• She has a total cholesterol value
of 235
Weight And Exercise History. In the last
year, Marsha lost over seventy pounds on a
very strict diet/exercise plan. In the last
three months she has been on and off of her
diet and has regained one hundred pounds.
When she started regaining weight she
found that she was also no longer able to
“stick” to her exercise regimen.
Intervention: Fixing The Machine. Given
this information and working from within
the traditional health promotion model, it
is likely that Marsha would have been
offered the following.
• A thorough cardiovascular
screening
• A fitness evaluation
• An individualized exercise prescription based on the results
of her physical testing
• A recommendation to join a
fitness facility or community
program for exercise
• A referral to a dietician for
weight loss and for suggestions
on how to lower her cholesterol
and blood pressure
• Information on stress
management classes
In summary, with the traditional biomedical approach we would have tested
and measured the physical aspects of
Marsha’s health and prescribed her an
exercise plan, eating guidelines, and stressmanagement techniques to help her be
physically healthier and less stressed.
Seeing Marsha
Through Holistic Eyes
Holistic Health Promotion reminds us
that we cannot look just at a person’s
physical symptoms and we cannot view
people as individuals in isolation from the
systems in which they live. It’s important
to see the whole person as well as the relationships and environments that surround
them. Considering Marsha’s life from a
broader holistic perspective can help us
learn whether she will have the time,
ability, or desire to follow the health
advice she is getting.
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Eating, Weight, And Body Image History.
Marsha has struggled with her weight for
most of her life. She has repeatedly lost and
regained weight since she started dieting as a
teenager. After rebounding from her most
recent diet and exercise plan, she feels she is
now constantly preoccupied with thoughts
about food and her weight. She reports
hating her body at her current size and starving herself periodically (usually followed by
bingeing). She has enjoyed group exercise
classes in the past, but after gaining one
hundred pounds she feels too embarrassed
to be seen wearing exercise clothes.
Family History. Her parents live two
hours away. Both are of African heritage,
and they are still married. Her mother was
recently hospitalized for three weeks due to
agoraphobia (fear or avoidance of open or
public places). Her father has hypertension
and diabetes. He was recently hospitalized
with serious heart trouble and given two
years to live. Marsha travels to and from
her parent’s house, 120 miles away, in order
to help them with their health problems.
She has one older sister, who lives near her,
and one younger brother out of state. She
is not on speaking terms with either
sibling, although she was very close to her
brother 10 years ago. Neither her brother
nor her sister assists in the care of her
parents, who are steadily becoming more ill
and less able to care for themselves.
Relationship History. Marsha is heterosexual and has been married twice, the first
time at age 20. This marriage ended in a
traumatic, bitter divorce after five years due
to her spouse being unfaithful. She is
required to have ongoing contact with her
first husband because of his visitation
rights with their child. She experiences
almost constant stress due to bitter
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ongoing struggles with her ex-husband
around his failure to pay child support.
Marsha avoided intimate relationships
for 13 years after her divorce. She then
became involved in another love relationship and married a second time at age 34.
This second marriage lasted three months.
She has not been involved in an intimate
relationship since the second divorce five
years ago. Marsha has one child, a daughter
who is 16 years of age. She has primary
custody of her daughter, who has always
lived with her. The daughter spends very
little time with her father, who lives out of
state, moves frequently, and often remarries.
Education/Job. Marsha has a high-school
degree and has been in her current job for 10
years as a support person in a large, conservative, white-male-dominated organization.
She is part of a staff comprised of Africanand Latino-heritage women. Her supervisor
is a white male with an autocratic leadership style. Their work group has had staff
reductions three times in the last four years.
Her job includes daily, urgent deadlines and
requires that she sit at her desk on the
phone and/or at the computer most of the
day. She works 10-hour days on average
and some weekends. The company medical
department recently sent her home on
Valium after an anxiety attack at work.
Finances. As a single mother on a low
support-staff salary, Marsha lives under
continuous, extreme financial pressure.
She gets by paycheck to paycheck, is trying
to pay off credit card debt, and is worried
about helping to pay for her daughter’s
college tuition in a year.
Social Environment. Marsha reports no
social activity. She cannot remember the
last time she did something that was “fun,”
and says she cannot afford to go out to eat
or to the movies with others. She feels she
is too depressing to be around, so she
avoids her friends. She used to attend
church regularly but says she has lost
interest and is too tired to attend.
Intervention: Healing The Whole
Person. When we look at this comprehensive view of Marsha, the limitations of
traditional biomedical health assessments
and recommendations become all too
obvious. It is hard to imagine that exercise
prescriptions, eating plans, and stress
management guidelines are going to help
this woman, who is physically, emotionally, and spiritually exhausted. She is
dealing with overwhelming relationship,
financial, and job stress issues, all made
even more difficult by the fact that she has
no significant social or spiritual support
systems to help her. It is certainly not surprising that she is experiencing physical
and emotional manifestations of her stress
such as headaches, high blood pressure,
high cholesterol, emotional overeating,
anxiety, and depression.
It is clear that Marsha is unlikely to have
the time, energy, or money to join a traditional exercise facility or take weight
control and stress management classes. In
addition, the behavioral techniques
employed by these traditional interventions would merely teach her how to keep
herself “under control,” essentially distracting her from the deeper issues in her
life that need healing. The behavioral
changes accomplished through these types
of programs are usually only temporary
anyway. By pursuing this approach,
Marsha would be setting herself up to
relapse into her old coping behaviors just
as she has done before.
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“How can exercising
and eating less salt
and fat possibly ‘fix’
Marsha’s life? They
cannot because they
do not address the
relationship, job, and
financial stresses that
lie beneath her
‘health problems.’”
Helping Marsha Holistically
Listed below are more holistic types of
help Marsha might access in order to heal
and move toward better health. Please
note these ideas provide only a brief
overview of some alternative ways of supporting people.
• First and foremost, Marsha
needs loving, compassionate
human support. Providing her
with a regular opportunity to tell
her story and express her emotions would be very healing. This
simple type of support could be
effectively provided by a health
educator, a therapist, clergy, or a
very good friend. It would be a
big first step toward helping her
to break out of the extreme social
isolation and hopelessness she is
experiencing.
• Marsha could benefit from
financial counseling to help her
consolidate debt, simplify her
finances, and plan for her retirement and the future health needs
of her parents. Assistance with
applying for scholarships or
college loans for her daughter
would also be helpful.
• Marsha could be connected to
community
agencies
that
provide low- or no-cost assistance and advice to people who
are caring for elders. Setting up a
network of support where her
parents live would reduce the
stress she is experiencing around
shouldering the burden of their
care alone.
• Marsha could be encouraged to
access resources provided by her
employer such as Human
Resources Department counseling
for career advancement or
company-subsidized education
programs to help her obtain a
college degree. Also, the company
employee assistance program
might provide counseling and
therapy to help her pursue healthier intimate relationships in the
future and heal the estrangement
with her siblings.
• Information and support regarding programs that address
compulsive eating, chronic
dieting, and body hatred would
help her move to a less painful
place with food and her body.
• A size-friendly exercise environment that includes special
exercise classes designed for the
needs of large people would be
helpful. The classes should be
taught by large instructors, and
should feature protected locker
space and large towels.
• A support group for African-heritage women could help her
understand and heal the life-limiting distresses she has acquired
in relation to women’s oppression and racism.
The importance of helping people with
the source of their distress cannot be
overemphasized. How can exercising and
eating less salt and fat possibly “fix”
Marsha’s life? They cannot because they do
not address the relationship, job, and
financial stresses that lie beneath her
“health problems.” Whether it is fitness
level, weight, smoking, blood pressure,
cholesterol, or “stress,” all of these issues
can be more compassionately and effectively addressed using holistic approaches
that respond to the whole person and the
environment in which she lives.
Summary
Upon hearing about a person like Marsha,
many health professionals say, “Wow, her
life is really painful and complicated. I can
see why she would have health problems,
and I can see that she needs a lot more
than eating guidelines and an exercise
plan.” But they then go on to say, “Most
people do not have such difficult lives,
and if they do, they are not going to share
all of that information with me when they
are just coming in for cholesterol guidelines!” It is very important to understand
that the vast majority of people have lives
that are just as complicated as Marsha’s.
The details of other peoples’ lives may be
different, but the level of challenge is
often just as high. And most of these
people are dying (sometimes literally) to
share the story of their lives with someone
who will listen without advising or
judging them. If you provide this service,
they will come, and it will help!
ABOUT:
Karen Carrier, MEd
Karen Carrier has a master’s degree in
Exercise Science from the University of
Houston and spent 15 years working in
the area of organizational health promotion. She was part of the original
design and ongoing development of
Conoco Inc.’s employee wellness
program; one of the first holistic corporate programs anywhere in the country.
She has also been an advocate for the
non-diet, size acceptance movement for
many years. Karen is currently President of Human Solutions, Inc., and an
adjunct professor at Nebraska
Methodist College. She lives in Dallas,
Texas with her husband Max and their
two daughters Lindsey and Madison,
and enjoys spending a great deal of time
with their two dogs and three horses.
Karen can be reached by emailing her at
[email protected].
All information © Wellness Councils
of America (WELCOA) 2004.
WELCOA provides worksite wellness products, services, and information to thousands
of organizations nationwide. For more information visit
www.welcoa.org.
Suggested Citation: Carrier, K. (2004). Seeing Things
Through Different Eyes. WELCOA’s Absolute Advantage
Magazine, 3(7), 16-19.
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The
Kailo
Concept
Kailo, an Indo-European word meaning “to be whole” or “of good omen,” is the
name of a non-traditional, hospital-based employee wellness program developed at
Mercy Medical Center-North Iowa. Kailo is one of the first worksite health promotion
efforts in the country to fully embrace a holistic approach.
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| By Kelly Putnam, MA
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WELCOA
The Kailo staff provides a wide variety of Holistic Health Promotion programs
to approximately 2,800 employees at Mercy Medical Center - North Iowa.
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I
I’d like to tell you Kailo was born as a result of some deep inner
wisdom or spiritual epiphany, but the truth is, our decision to “go
holistic” was primarily driven by customer service. We certainly
never intended to create something so unique in the world of
worksite health promotion. We were led there by listening to the
2,800 people who work at Mercy, nearly 90 percent of whom are
women. In surveys, focus groups, and individual interviews,
Mercy staff identified their primary health concerns as psychosocial and spiritual in nature. Stress, depression, relationship issues,
and domestic violence were having the most negative impact on
their health and productivity in the workplace. And it was our
search for a way to address these issues that ultimately led us to
Dr. Jon Robison and Karen Carrier’s holistic approach.
Despite a lot of lip service being paid to mind-body-spirit
approaches, our perception of the dominant model for worksite
health promotion was that it was still very much entrenched in a
one dimensional process—to reduce biomedical risk factors for
disease. Not only was this approach a mismatch for Mercy, it did
not seem to be all that successful. Many traditional programs
were struggling with participation, funding, staffing, formal planning, evaluation, and demonstrating meaningful outcomes.
By contrast, the holistic approach seemed to make more sense
for our worksite population. It focused on strengths rather than
weaknesses; it pulled into balance all aspects of health and wellbeing; it honored relationships and purpose and meaning in life
as the primary determinants of health; and it emphasized compassion and connection over competition. But would it be
successful? To be honest, no one really knew. You see, at the time
there were no existing “best practices” from which we could
model our program.
As wary Midwesterners not wanting to fall victim to something
so “touchy-feely,” we spent the next few months researching other
bodies of scientific knowledge in search of support for Robison
and Carrier’s approach. Much to our delight, we found significant
validation for their ideas in some surprising areas including (1)
Pareto Theory—which says that 20 percent of an organization’s
employees are driving 80 percent of healthcare claims costs and
the majority of the “pareto group” is utilizing healthcare benefits
for psychosocial issues; (2) Relational Theory—from the Stone
Center at Wellesley College. Relational theory suggests social connectedness is the primary determinant of health; (3) The positive
psychology movement—which emphasizes a strengths vs. weaknesses approach to well-being; and (4) Gallup research in
organizational development—Gallup has determined that relationships are also what drive organizational health and vitality.
Having finally satisfied our considerable skepticism, we decided
to move forward with developing the Kailo concept and scheduled the official kick-off for January 1, 1998.
Kailo Programming
Mercy employees join Kailo by filling out a survey packet that allows
us to track outcomes. In exchange for their time, Kailo members
receive the following programs and services free of charge.
• Kailo Breaks—Similar to lunch ‘n learns, Kailo Breaks
are offered multiple times monthly. Local and national
speakers are utilized. Employees attend on paid time and
are treated to lunch. All sessions are videotaped and
available for checkout through the Kailo library.
• Kailo-To-Go—A series of 30-minute programs that can
be delivered (with lunch) to Mercy departmental meetings 24-hours-a-day, seven days a week.
• Kailo for One—A customized wellness service that offers
Mercy employees and their immediate family members
unlimited free access to counselors, nutritionists, nursing
case managers, spiritual care providers, and career
coaches.
• Intensive Workshops—A more in-depth form of Kailo
Breaks, these workshops cover a wide range of wellness
topics including body image and spiritual development.
• Recreational Rebates—Kailo members who join health
clubs or pay for fitness classes in the community can earn
up to $50 per calendar year toward the cost of club dues
or class fees.
• Free Health Screenings—Blood pressure, cholesterol,
and bone density heel scans are offered annually.
• Kailo Library—Over 1,500 titles of books, videos, and
audio-cassettes available for checkout. Our library can be
accessed by visiting the Kailo office or by logging onto
Mercy’s Intranet.
The Kailo-To-Go “menu” offers a series of holistic wellness
programs available 24-hours-a-day, seven days a week.
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• Gentle Fitness Classes—Gentle Fitness is a form of mindbody exercise that combines yoga, low-impact aerobics,
and relaxation techniques. The class is open to all fitness
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levels, but particularly appeals to employees who are new
to exercise and/or who have special physical challenges
(e.g., back pain, arthritis, muscle stiffness and soreness).
• Kailo Birthday Club—Each year Kailo members
receive a birthday present.
• Other Stuff—Onsite mini-massages, walking club, silly
contests, etc.
At first glance, Kailo may not look all that different from traditional wellness programs. But look closer. What you won’t find
here are some of the hallmarks of traditional worksite health promotion—health risk appraisals, weight loss programs, incentive or
point systems, just to name a few. What makes Kailo so fundamentally and philosophically different from other wellness
programs are the basic assumptions of our concept.
The Kailo Concept
• We do not focus on reducing biomedical risk factors for
illness; we focus on bolstering physical, psychosocial,
spiritual, and relational factors that support health.
• We honor relationships and purpose and meaning in life,
rather than health risk appraisal scores, as the most powerful predictors of health and well-being.
• We base our outcomes on participation, customer satisfaction, and improvements in perceptions and attitudes
toward work and life satisfaction, rather than behavior
change and biomedical indicators.
• We value connection over competition.
Marketing Kailo To Mercy Employees
Mercy employees were very skeptical, and even cynical, about Kailo
in the beginning. Our challenge was to figure out how we could use
marketing to help foster a relationship with our customers, soften
attitudes, and create a space in the organization for the program to
succeed. Taking our cue from the holistic approach, we paid careful
attention to the images and words used in our marketing materials.
Fear, guilt, and shame-based messages were off limits as were
photos of unrealistically thin and fit models. Instead, we used language filled with validation, empathy, compassion, and humor and
visual images of “real” people to begin a long-term conversation
with Mercy employees that went something like, “We hear you,
you’re stressed out. You are not alone. We think we may be able to
offer you some help. Give us a chance.”
Although many marketing campaigns focus on building positive relationships, the end goal is usually to sell a product or
service (commercial marketing) or increase the likelihood of
behavior change (social marketing). The end goal of Kailo’s marketing, something we’ve dubbed relational marketing, by
contrast, is the relationship itself. As Holistic Health Promotion
practitioners we believe social connectedness and support are the
most important predictors of health and well-being. We define a
successful marketing campaign as one that inspires conversation
and authentic human connection that transcends the wellness
program and even the workplace, and trickles into the homes and
communities of our employees.
Outcomes
Mercy employees’ response to Kailo has exceeded our wildest
dreams. Six years after the program’s kick-off, our participation
and customer satisfaction scores have never been stronger. Our
Kailo offers a number of one-on-one initiatives designed to help employees cope with depression, anxiety, relationships, and other personal issues.
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ABSOLUTE ADVANTAGE
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ABSOLUTE ADVANTAGE
outcomes, as measured by Karen Carrier’s Life’s Odyssey: Creating
a Conscious Healthy Journey, indicate our employees are thinking
and feeling more positively about their health and well-being.
Other outcomes associated with Kailo include:
• A by-proxy cost-savings estimate of over $200,000 associated with reducing depression among Mercy employees.
• A 171 percent increase in EAP utilization in the first
year of Kailo for One followed by an additional 67
percent increase in the second year.
• 76 percent of employees agree Kailo is a valuable benefit
of working at Mercy (N = 1173).
• 52 percent of employees agree Kailo has had a positive
impact on how they view their health (N = 1169).
In addition, Kailo has received the following awards and
recognitions:
• Joint Commission for Accreditation of Healthcare
Organizations (JCAHO) “Best Practice,” 1999.
• Wellness Councils of America (WELCOA) Gold Well
Workplace 1999.
• Trinity Health Excellence and Innovation Award, 2001.
• Iowa Psychological Association’s “Psychologically
Healthy Workplace Award,” 2002.
• WELCOA Platinum Well Workplace Award, 2002.
And Now A Word From Our CEO…
So has our experiment in adopting a holistic approach to worksite
health promotion been successful? Perhaps our CEO and President, James Fitzpatrick can answer it best. He says, “Kailo is a
shining example of Mercy values and commitment to excellence.
We have taken risks and proven our approach works. This is not
fluff. Making investments in the health and wellness of our colleagues is at the heart of what we are about.”
Employees Speak Out
Kailo Works!
As any health practitioner knows, a worksite wellness
program is only as strong as it outcomes. And even
though our approach is a bit unorthodox, we work diligently to collect data to demonstrate how Mercy
benefits from Kailo. Sometimes that data comes in the
form of large surveys, focus groups, or one-on-one
interviews, but we also make it a point to include anecdotal evidence as well. What we’ve found is, more often
than not, our most meaningful outcomes become clear
when we share the individual stories of the people who
have used our programs and services.
Katie*
“It’s simple,” says Katie, an extroverted, energetic 43-yearold recently-divorced mom who has been working full-time
at Mercy for 15 years. “I wouldn’t be here if weren’t for Kailo
and especially Kailo for One. I know I wouldn’t be working
here—I would have been fired by now,” she chuckles. “But
the truth is, I might not be here physically either—and by that
I mean I may not have been alive.”
Katie’s comments may seem extreme, but her story assures
us she is not kidding. After her father died nearly 10 years
ago, she assumed the role of caretaker to her surviving
mother until her passing three years ago. During this time, she
was also struggling to save her troubled marriage, having dif-
ABOUT: Kelly Putnam, MA
ficulty with one of her adolescent children, and starting a new
Kelly Putnam, MA is the Health Promotion Coordinator for
Mercy Medical Center-North Iowa and the Executive Director
and creator of Kailo, a non-traditional approach to worksite
wellness. A health educator since 1993, Kelly was the wellness
coordinator for North Iowa Area Community College prior to
starting at Mercy in 1997. She developed the Kailo concept—
one of the first holistic, relationship-oriented wellness programs
to be launched in a healthcare setting. The Kailo program has
resulted in significant improvement in employees’ perception of
their health and happiness. Kailo has received a JCAHO “Best
Practice” citation, a Platinum Well Workplace designation from
the Wellness Councils of America (WELCOA), the Trinity
Health Excellence and Innovation Award, and the Iowa Psychological Association’s Psychologically Health Workplace Award as
well as several national healthcare marketing awards. You can
reach Kelly by emailing her at [email protected].
position at work. The stress began to take its toll on Katie’s job
and her health.
“I have struggled with depression my whole adult life,”
she says. “But this was really bad. I didn’t care about anything—how I looked, how I treated people—I just didn’t
care. It impacted my ability to do my job. I used up all my
vacation and sick days and was even ‘written up’ (disciplined) for being either late to work or absent too much.
I had headaches, heartburn, stomach problems. I had colds
that wouldn’t go away and body aches and pains that I couldn’t explain. I gained over 50 pounds. I started smoking again.
I was so depressed and emotionally exhausted,” she recalls.
Following a suggestion from a co-worker, Katie made her
first appointment to talk with the Kailo for One provider (a
All information © Wellness Councils of America (WELCOA) 2004.
WELCOA provides worksite wellness products, services, and information to
thousands of organizations nationwide. For more information visit
www.welcoa.org.
Suggested Citation: Putnam, K. (2004). The Kailo Concept. WELCOA’s Absolute Advantage Magazine, 3(7), 20-25.
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licensed independent social worker) and has been using the
service from time to time ever since. As a result of her sessions, she began to process and grieve the loss of her
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Employees Speak Out: Kailo Works (continued)
parents. She also realized her marriage was not salvageable
to talk with the Kailo for One provider. Her sessions focused on
and filed for divorce.
how she could better manage the relationships in her depart-
“For me, being able to come here (the Kailo office) and get
ment through means that felt true to her personality and
help with whatever’s going on in my life is a life-saver. Kailo is a
leadership style. Within weeks, Sandra could see and feel a big
little extra source of support and security that no one else in my
improvement. She still uses the Kailo for One service on occa-
life has to know about. And it helps. It really helps,” says Katie.
sion to help her sort out issues that come up in the department,
Today, Katie still comes to Kailo for One occasionally, she
attends Kailo Breaks when time allows, and has become a
but overall is feeling much stronger about her ability to manage
her staff.
regular patron of the wellness library. She likes her job, is per-
“If it weren’t for Kailo for One, I probably would not have
forming much better at work, and has far fewer health problems.
been able to stay in this job,” Sandra says. “It is a great service
“I have gotten back to where I appreciate myself again,” she
not only from the perspective that it helped me become a
says, “and for me, that is what it all comes down to.”
better leader, but it is something I can refer my staff to when
they are struggling with issues at work or at home. Offering
Sandra*
this resource to my employees when they are in need helps me
As a 10-year veteran nurse at Mercy, Sandra was competent
feel like I’m doing a better job as their supervisor.”
and self-assured in her patient care skills. But when she
changed departments and only months later was promoted to
Connie*
supervisor of her new colleagues, everything changed.
Connie is a 20-something lab employee who wrote the follow-
“It was a very tough working environment,” she explains. “I
had less tenure than the other people in the department, yet I
had been the one chosen for promotion. What’s more, there
her family.
Dear Kailo,
were some long-term issues with a few problem employees
I come to Kailo Breaks because it is a great stress-reliever
that had been allowed to go on for years and I was now expect-
during the work day and because the content is interesting. The
ed to be the one to deal with them.”
Kailo team does a great job of choosing interesting/relevant
What started out as jealousy over a promotion decision soon
topics and speakers. I also enjoy having a bit of time to myself
escalated into a department out of control. Sandra endured
during the day. It makes me feel more like a person and less like
back-stabbing, lying, and rude and disrespectful behavior at the
one of the herd of employees.
hands of her staff on a daily basis. Understandably, she began
questioning whether she was cut out for a management role.
I also appreciate the access to health information provided by
Kailo. Without Kailo, I would not know about opportunities like the
“I was beaten down by my environment everyday,” she says.
Walking Club, the Fitness Rebate, and the Kailo for One service.
“I found myself obsessing over things that would happen at
These are great programs but they aren’t very helpful if employ-
work and how I might have handled them differently. I really
ees don’t know about them!
wanted to do a good job but I felt so incompetent. My director
Most importantly, Kailo has introduced the human factor to the
would tell me to ‘just get tough’ with my staff and I wasn’t com-
different programs and departments represented at Kailo Breaks.
fortable with that—it’s just not who I am.
Actually meeting people from different departments at Kailo
It definitely impacted my life at home and my health,” the
makes them seem more approachable. Folks are more likely to
wife and mother of two continued. “I would be so emotionally
stop by your office for information or seek help from Kailo for One
drained by the time I got home in the evening, I didn’t feel like
if they already feel they know you from seeing you at Kailo. The
doing anything or talking to anybody the rest of the night. In
human factor is SO important!
fact, I felt so miserable that I finally just gave up exercising,
and that is something I have been doing my whole life.”
At her supervisor’s suggestion, Sandra made an appointment
2004 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG
©
ing letter to the Kailo staff in 2002 before leaving Mercy to start
Thanks, Connie
*Names and non-essential details have been changed to honor
the privacy and confidentiality of Kailo participants.
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Deadlines!
Financials!
Board Meetings!
Spiritual Connections?
Can holistic health fit
within the confines of
traditional corporate culture?
Imagine this scene
By Walter S. Elias, PhD
in the CEO’s office...
“JB, we have scheduled
the executive staff into
‘Spiritual Connections’ at 4:30.
‘Perceived Happiness’
is tomorrow’s brown-bag
lunch topic.
Oh, by the way, someone
from the SEC is here
to see you regarding those
financial reports you certified.”
It seems there is something
marvelously incongruous
about a holistic approach to
health and wellness and the
stereotypical corporate culture.
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S
Since the Industrial Revolution, corporations have tried to mirror themselves on
the machines that fill their factories: input,
process, output. Efficiency is the watchword. If we can’t do it efficiently, we’ll
outsource it. Henry Ford laid out the
factory floor for systematic assembly and
we long for that same model of efficiency
in every part of our corporate lives.
Traditional health and wellness practices
fit well into the “Deus ex machina” model:
aberrant behaviors are identified and programs instituted to modify those behaviors
under the fundamental belief that health
can be achieved, if only we follow the right
formula. We are suckers for the “Ten Steps
to Instant Health” approach.
But somehow, somewhere, there is
clearly a disconnect. Despite the fact that
80 percent or more of American corporations are investing in workplace wellness
programs, healthcare costs continue to
rise at many times the rate of underlying
inflation. A Kaiser Foundation survey in
the fall of 2003 showed that health insurance premiums rose at a 15.5 percent
annual rate for companies with less than
200 employees and at a 13.2 percent rate
for larger enterprises.1 Whatever corporations are doing in the area of health and
wellness promotion, it is clearly not
working as well as it needs to work.
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A New Science
About 100 years ago, Max Planck determined that emitted radiation from a body
was not a continuum of values, but rather
the sum of many quantized contributions.
Quantum physics was born and it
changed the way we perceive the universe.
Unfortunately, while science was exploring the dynamics of creation, the intricate
connective web of the universe, and the
unpredictability (chaos theory) of
complex systems, healthcare and wellness
programs remained locked into simplistic,
cause-effect reasoning and mass promotions that ignore the realities of human
existence. Only very recently, for example,
have wellness programs been incorporated
with disease management and EAP programs into fledgling population health
management programs. The bankruptcy
of our standard approach is made clear by
the US’ $1.6 trillion healthcare bill.2
There have been many voices over the
years pointing out the error of this
approach. People like Dean Ornish, Larry
Dossey, Karen Carrier, Jon Robison and
many others have promoted a mind-bodyspirit approach to health and wellness
under the banner of “Holistic Health Promotion.” They sought to broaden health
promotion and include the entire human
and his or her work and home environment in promoting individually optimized
health. Traditionalists dismissed Holistic
Health Promotion as “new age hoopla.”
The connotation was that this was a lot of
crystals and sweat lodges and ritual
dancing, not far removed from what we
suspect our ancient ancestors did in their
caves to drive away evil spirits. In fact,
Holistic Health Promotion is in tune with
the latest in scientific thinking. It brings
together mind, body, and spirit with a goal
of “living well, despite our inescapable illnesses, disabilities, and trauma.”3 It is an
approach well grounded in reality that
accepts humans as complex systems and
explores how each human can thrive
within his or her myriad of health-affecting relationships. A new scientific
discipline “psychoneuroimmunology” or
PNI gives the holistic approach legitimacy.
One Size Does Not Fit All
There is quite a body of literature supporting the mind-body-spirit connection
in health.
Looking for a magic “holistic” program,
however, would completely miss the
point. Holistic Health Promotion is not a
mass-market but an individual strategy.
By definition, all group and standardized
approaches ignore the most important
elements of individual health and wellness. They do not and cannot deal with
the thousands of unique factors that
impact each individual’s health state. A
true holistic approach to health must deal
with each person as a unique individual,
with his or her own unique combination
of mind-body-spiritual factors. It must
deal with the individual’s web of relationships and help the individual find a path
to “living well” within the context of
those relationships.
There is value in various coursework,
books, motivational tapes and the like
with regard to helping individuals understand their own mind-body-spirit niche.
But such materials have value only if the
individual participates and is able to
incorporate the suggestions within her
worldview. The challenge in corporate
health promotion has always been getting
participation from the people who impact
corporate healthcare costs the most—the
so-called Pareto Group.
The Pareto Group is that small percentage of any population that represents the
lion’s share of whatever it is you are measuring. This 80/20 rule seems to apply to
every facet of life and there is no surprise
that healthcare claims data invariably
show that a handful of employees represent the vast majority of healthcare outlay
in any given year. In one study at U-Haul,
two percent of employees represented 40
percent of claims, for example.4 If US corporations are ever going to bring
healthcare costs under control, they must
address the high utilization group. The
corporation must ask, “Can a holistic
approach effect Pareto Group usage?”
The Pareto Group comprises a variety
of utilization causes and needs. They are
as follows.
• One time events such as accidents and contagious diseases
• Normal, high-cost events such
as pregnancy
• Manageable chronic disease
and/or disabilities and their consequences
• Preventable disease or injury
• Somaticization—patients with
bodily complaints may have an
organic illness, a psychiatric disorder, or significant emotional
distress being expressed through
somatic symptoms
• Moral hazard—the unfortunate
tendency of insurance to make
certain injuries and accidents
“profitable.” The insurance and
“Holistic Health Promotion lists social isolation as
a primary determinant of ill health.”
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“Holistic Health
Promotion is not a
mass-market but an
individual strategy.
By definition,
all group and
standardized
approaches ignore
the most important
elements of
individual health
and wellness.
They do not and
cannot deal with the
thousands of unique
factors that impact
each individual’s
health state.”
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legal systems make it easy for
some employees to file claims
such as “strains and sprains” and
“stress,” for example.
Traditional wellness programs have
focused on behavior-oriented causes of
disease or injury—the so-called preventable illnesses. But these are only one facet
of the many-faceted usage profile, and
behaviors themselves are often more accurately understood as symptoms, rather
than root causes. Study after study has
shown that these programs are missing the
mark. Following are some examples.
• The presence or severity of
symptoms
or
conditions
account for a surprisingly small
portion of the variability in
healthcare use. Studies have
found that only 12 to 25 percent
of healthcare use can be predicted by objective disability or
morbidity.5
• In a review of records of over
1,000 patients in an internal
medicine clinic over a three-year
period, in less than 16 percent of
cases the origin of somatic cases
was deemed to have an organic
cause. Seventy-four percent were
of unknown etiology.6
• Fifty to sixty percent of managed
care visits involve somaticizers.7
This process occurs when a
patient’s emotional state is either
expressed in physical symptoms
or intensifies existing symptoms.
Cases of self-reported pain
without objective physical or
laboratory findings are classic
examples. Such patients are the
cause of considerable frustration
and expense within the healthcare system.
• Attending to the psychological
needs of medical patients was
found to be advantageous both
economically and clinically.
Sixty percent of HMO visits
were by the “worried well” with
no diagnosable disorder. Not
only did psychotherapy help
these patients, but the direct
costs of providing for their treatment were offset by reductions
in general medical use.8
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“Holistic Health Promotion brings together mind,
body, and spirit with a goal of
“living well, despite our inescapable illnesses,
disabilities, and trauma.””
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To actually affect healthcare costs, a
corporation needs to address employee
and dependent behaviors in the context of
each individual’s environment and, likewise, address each of the other areas of
usage, as appropriate to that individual.
The goal should be an individual who is
managing her own health well and is
achieving a level of health and well-being
she finds acceptable in the context of her
life. If the corporation can help its
employees bring about that state, it can
expect fewer and less expensive claims
than it currently experiences and, if
provider charges per treatment remain the
same, overall costs will decline.
Thus it isn’t enough to simply think
holistically, and provide programs that
support mind-body-spirit awareness. One
must work with each individual and aid
her in getting to her own fundamental
health comfort level. That suggests applying the holistic approach within a
personal health-coaching model. (See
article on the Kailo program in this issue).
Measuring Success:
The Whole Is Greater
Than The Sum Of Its Parts
“But is it worth it?” corporations ask.
Cost-effectiveness requires that there be
a return on investment. And in the
context of health and wellness programming, the targeted return should be
measured in claims experience. But,
under a holistic approach, the measure of
success needs to be as individualized as the
programming. Success for a person with
diabetes, for example, may be fewer
claims for reasons that are consequential
to improperly managing her disease.
Success for a pregnant woman would be a
successful delivery without preventable
complications. Success for a person with a
history of somaticization would be fewer
medical visits for indeterminate causes.
Success for a person with no claims
history might well be periodic examination. The net result of these individual
successes should add up to a significant
return on investment for the corporation.
To date, to my knowledge, no one has
analyzed performance at that level.
While the corporation can and should
focus on these simple objective measures,
individuals should be focused on much
more subjective goals. For the individual,
satisfaction with the state of one’s mental,
spiritual, and physical health should be the
goal, and that satisfaction should be
expressed in a context meaningful to the
individual’s life. Spiritual health to some
may be feeling like a part of a welcoming
community of like-minded people. For
others, it may be periodic communing
with nature or simply moments of meditation. Mental health for some may involve
managing stress; for others avoiding
depression; for still others, narrowing the
swing between highs and lows or establishing and maintaining meaningful
relationships. Physical health can range
from keeping the body in peak physical
condition (Lance Armstrong) to simply
keeping physical disability from interfering
otherwise with life (Stephen Hawking).
Personal goals are just that, personal. But
the net result of an employee group each
achieving individual personal health goals
is quite likely a very productive workforce
that has fewer sick days, better workplace
safety, fewer workers’ compensation and
disability claims, and fewer and lower
healthcare claims. Again, the research has
yet to be done.
The cost of one-on-one, holistic health
coaching could be high. However, with
the Internet and telephone as media, it
need not be significantly higher per
employee than current health promotion
models. Again, the Kailo experience suggests that costs of this can be quite
reasonable. Among all approaches, a oneon-one holistic approach is the only
approach with significant success at reaching and effecting change within the Pareto
Group. Thus, in the measure of costeffectiveness, it will likely far outdistance
other approaches. Too few companies
have yet to step up to the plate and invest
in helping their employees each become
healthy within his or her own context.
Corporations investing in holistic
approaches are taking a chance. They are
plowing new ground with no guarantee of
success. The alternative, however, is clear.
The current approach results in healthcare
costs doubling every five years. Healthcare
cost issues are the root cause of most
organized labor disputes. They may well
be a significant factor causing corporations to export functions overseas to
countries with universal coverage or no
coverage at all. Healthcare may well be the
largest single drain on our economic
growth. Not addressing this issue is taking
an even bigger chance. Why not give this
new approach, Holistic Health Promotion, a try?
References
1. Kaiser/HRET Survey of Employer-Sponsored
Benefits, 2003.
2. Centers for Medicare and Medicaid Services, January 2004.
3. Briggs J., and D. Peat. Seven Life Lessons
of Chaos: Spiritual Wisdom from the
Science of Change. New York: Harper
Perennial, 1999.
4. Woolsey, C. Health Care Cost Control, Business Insurance, February 17, 1992.
5. Berkonovic, E., Telesky, C., and S. Reeder.
Structural and Social Psychological Factors
in the Decision to Seek Medical Care for
Symptoms. Medical Care, 19(7): 693-709,
1981.
6. Kroenke, K., and A.D. Mangelsdorff.
Common Symptoms in Ambulatory Care:
Incidence, Evaluation, Therapy and
Outcome. American Journal of Medicine,
86(3): 262-266, 1989.
7. Locke, S.E. Treating Somatization: An
Update. Behavioral Health Management,
July/August 1997. Pages 22, 24.
8. Cummings, N.A. & W.T. Follette. Psychiatric
Services and Medical Utilization in a
Prepaid Health Plan Setting: Part II. Medical
Care, 6: 31-41, 1968.
ABOUT:
Walter S. Elias, PhD
Walter S. Elias, PhD is the President of
Elias & Associates, Inc., a Minneapolisbased healthcare consulting practice
working with corporations, managed
care organizations, provider groups, and
the vendor community in population
health management. A complete description of his company’s services can be
viewed at www.eliasassoc.com. He can
be reached at (952) 546-0229 or
[email protected].
All information © Wellness Councils
of America (WELCOA) 2004.
WELCOA provides worksite wellness products, services, and information to thousands
of organizations nationwide. For more information visit
www.welcoa.org.
Suggested Citation: Elias, Walter S. (2004). Holistic
Health, Inc. WELCOA’s Absolute Advantage Magazine,
3(7), 26-31.
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BIG PICTURE
THINKING
Helping people improve personal health and well-being means making
the connection between mind, body, and spiritual wellness. Holistic Health
Promotion expert and this month’s guest editor, Jon Robison, PhD, MS,
recently sat down with WELCOA President, David Hunnicutt, PhD, to discuss
the interconnected nature of staying healthy and living well.
Jon, before we dive into the topic of Holistic Health
Promotion, I think it would be helpful if you first
discussed the biomedical paradigm of health.
Can you give us some background on that?
ROBISON: In order to understand where the biomedical paradigm of health comes from, you have to go all the way back to
the 17th century and the pervasive worldview at that time. This
worldview was decidedly mechanistic, meaning that the universe was considered to be a huge machine. All the components
making up this universe, including living things, were also considered to be machines.
Because people, as living things, were viewed as machines—
albeit very sophisticated ones—if something went wrong with
the human body, you simply took it apart, found the broken
piece, repaired it, and put it back together. At that point you’d
have a “healed” human being. In essence, healing humans came
via the same process in which a broken clock was repaired.
That model works really well for some things like fixing a heart
valve, curing an infectious disease, or mending a broken leg. But
when you start to look at the major health problems today (like
cancer, heart disease, osteoporosis, chronic fatigue syndrome,
fibromyalgia, and, of course, anything behavioral), the biomedical
paradigm doesn’t work so well because all of these conditions are
extremely complicated. Looking at these modern conditions from
a biomedical, mechanistic viewpoint simply doesn’t work because
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human beings are, in fact, not machines. In these cases, you can’t
just tear the clock apart and fix it.
That’s well said, and it’s a fair summary of where
we are. You spoke of PNI in your opening article as a
counter to the exclusively biomedical approach. Can
you introduce PNI again?
ROBISON: Sure. PNI stands for psychoneuroimmunology (which is
a ridiculously long word) but an easy one to understand. Psycho is
for the mind, neuro is for the nervous system, and immunology is
for the immune system. We have learned from psychoneuroimmunology that all of these systems are interconnected. They are
not—as many of us were taught in school—separate systems. That
view harkens back to the 17th century world when everything was
partitioned off into its own little compartment.
But we now know these three different systems are interconnected. That means all of the emotions and feelings we have
get translated into biochemical reactions within the brain and
body. Our physiology is affected by our emotions, and our
emotions are affected by our physiology. There’s been a tremendous amount of research in this very new science, dating back
only to about the 1950s.
So, in a nutshell, that’s what psychoneuroimmunology is all
about—all the body’s systems are interconnected. That reality
plays a big role in truly understanding what Holistic Health
Promotion is all about.
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How does PNI play into the importance of having
purpose in life, spiritual connectedness, and social
support?
ROBISON: Studies are now showing a strong correlation between
having high levels of social support and living a long, healthy
life. Scores of observational studies suggest that people who have
social support seem to live longer and have less heart disease.
There are also many studies showing that emotions, feelings,
social support, and spirituality can affect the immune system.
For instance, people who are measured as being very optimistic
tend to have stronger immune systems. They actually have more
white blood cells to fight off disease.
So it seems the PNI connection is a pretty powerful one. Of
course, until very recently, we wouldn’t have even thought about
this because we would have classified the mind, body, and spirit
as separate systems. And we would have ignored the less tangible
mind and spirit because only things we could measure could
possibly affect our health. PNI has helped us to understand that
this is not the case.
Remember, this is really the beginning of this research, so I
think it’s important not to oversimplify and say, “If you go out
and get 10 friends, that means you’re not going to get cancer.”
That’s ridiculous. But there does seem to be a strong connection
between having social support and living a healthy life.
We’ve known for a long time that whatever is going
around, the poor get more of it. What about the
relationship between socioeconomic level and poor
health? How does PNI play into that?
ROBISON: The literature is pretty clear—the bulk of illness is
borne by the poor. I don’t think there’s much question about
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that. But, teasing out all the factors involved in why this is the
case, that’s pretty difficult.
Obviously, lack of access to healthcare plays a big role. People
who are poor and don’t have any health insurance have less
access to healthcare. That’s a major problem even in this country, the richest country in the world. There are also other reasons why poverty and poor health are connected. If people are
living in substandard housing, if they are constantly struggling
to make ends meet, if they’re not eating well, if it’s too dangerous for them to go out and be physically active because they’re
liable to get shot, all of those things contribute to the gap
between the rich and the poor when it comes to health.
So it’s a very complicated issue, but I think you bring up a critical point. Very often I fear that, in traditional health promotion,
we’re so focused on biomedical risk factors that we don’t realize
that biomedical risk factors are often really symptoms—the causes
are environmental, perhaps ecological is a better word. In many
cases, people have high blood pressure, eat poorly, or aren’t physically active because of the web of circumstances in which they
live, and they end up with diseases and risk factors as a result.
If we spend 95 percent of our time and resources trying to
fight these risk factors and behaviors instead of trying to do
something about the underlying causes—be they environmental,
psychological, emotional, or spiritual—then I think we’re wasting a lot of our effort, and we’re definitely not getting the maximum bang for our buck.
I’ve heard it said before that if we really want to improve the
health of the poor, what we ought to do is help them to climb
up one rung on the socioeconomic ladder instead of trying to
put them on an exercise program. That makes a lot of sense. I
mean who’s going to go for a jog in the middle of a neighborhood riddled with gunfire?
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“If we spend 95 percent of our time
and resources trying to fight these
risk factors and behaviors instead
of trying to do something about the
underlying causes—be they environmental, psychological, emotional,
or spiritual—then I think we’re
wasting a lot of our effort, and
we’re definitely not getting the
maximum bang for our buck.”
In your view of how PNI and the traditional biomedical model interact, do you think it’s possible to
have unhealthy behaviors from a biomedical perspective but to have protective factors from a PNI
perspective and not express illness? For example, is
it possible for someone to smoke but, because they
have a sense of purpose and social support, not to
express illness?
ROBISON: Smoking is a tough example because it has been
proven to be so toxic. (Although let’s face it, there are some people who smoke and live to be 90 without any problems). Let’s
take an example that’s less obvious but still very powerful, the
Rosetta study.
The Rosetta study was conducted back in the 1930s. Researchers
looked at a little community in Pennsylvania named Rosetta, and
found people living in this community had about half the heart disease rate of the communities immediately surrounding.
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Those living in Rosetta had the same risk factors as those in
the surrounding communities (they were also drinking the same
water, etc.), and there didn’t seem to be a big difference between
the communities at first glance. So the researchers investigated
this town for about 50 years and discovered that the town was
settled by a very tightly knit group of Italian immigrants. They
all worshiped together, worked together, recreated together, and
they all intermarried.
The researchers hypothesized that this social connectedness
was somehow protecting the town’s inhabitants from the ravages
of heart disease. They also hypothesized that over the next 50
years, as the community began to spread out and lose some of
its interconnectivity, that heart disease rates would rise to the
levels found in surrounding communities. Sure enough, that’s
what happened. Within a very short period of time, 30, 40, 50
years—not a very long time in this kind of study—even though
the risk factors didn’t change, heart disease rates in Rosetta
increased dramatically.
Now having said that, I want to be really careful, and say
again, there’s no panacea about this. These studies don’t mean
that if you get a massage three times a week, meditate, and
never move out of your parents’ house you’re guaranteed not to
get heart disease. On the other hand, I think these types of
studies do show that supportive factors for health—things like
meaning and purpose in life, touch, emotional expression, spirituality, etc.—are at least as important as traditional biomedical
risk factors like cholesterol, high blood pressure, and sedentary
living. You’ve got to take into consideration all of these factors if
you’re going to help people to the fullest.
What advice would you give our readers about
embracing the complexity of the biomedical model
and the PNI model without abandoning either one?
What’s the best thing to do?
ROBISON: There are a couple of things. First, it’s important to
realize that separately, neither model makes sense for the same
reason, i.e., holistic means “both.” So you can’t have one without the other. If all you’re looking at is meditating and feelings,
you’re going to miss half the boat. If all you’re looking at is
blood pressure, weight, and cholesterol, you’re going to miss half
the boat. Why? Because human beings are not machines. We
can’t be torn apart and fixed like clocks. We have to look at
health from the big picture perspective.
The next thing I would suggest to practitioners to help them
embrace the complexity of Holistic Health Promotion is to read
as much as possible about PNI, and about the “new” sciences—
quantum physics, chaos theory, etc. We need to understand that
science is not static. Science is always changing, and the science
upon which we predicated our understanding of human health
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and human behavior has evolved tremendously in the last 100
years. Many of us—physicians, nurses, dieticians, exercise physiologists, health educators, social workers, psychologists, etc.—
are really behind the times. We need to catch up because we’re
missing a lot.
I don’t want to sound too new-agey, but if there’s one message
I want people to walk away with, it’s how interconnected everything is, which is exactly what the new science is saying.
Quantum physics is all about connections, and this has tremendous relevance from a health perspective. If you look, for example, at the incidence of asthma in kids in New York City, there
are so many variables to consider (like genetics and what these
kids are eating, etc.). But when you realize that most of the
diesel bus terminals in New York City are located within close
proximity of where the highest levels of asthma are, you gain a
whole new perspective, a perspective that’s holistic, ecological,
and interconnected.
In quantum physics they say the whole is greater than the sum
of the parts. Health professionals really need to understand the
whole first before they can understand the parts, not vice versa.
How does one view the obesity epidemic within the
holistic framework?
ROBISON: I think the term “epidemic,” when used in relation to
obesity is more of a scare tactic than it is a scientific term. If you
look at the US population, in the last 10 years the average adult
has gained eight or nine pounds according to the CDC. To me,
that’s hardly an epidemic.
It’s important to remember, too, that the weight of populations is increasing everywhere on the planet with the exception
of some of the countries in Africa, where 60 to 70 percent of
the people have AIDS.
Why are humans getting heavier? There’s actually a very simple
answer to that question. We’re moving away from cultures that
used to require a lot of physical activity and where there wasn’t
much food, toward cultures where food is plentiful and where it
is becoming easier and easier to be sedentary. This trend in the
cultural evolution of our species results in heavier people.
The more interesting question is, what are we going to do
about our weight gain? From a holistic point of view I believe
there’s nothing we can do about populations that are getting
heavier—just like there’s nothing we can do about populations
getting taller. What we can do is focus on helping people to be
healthier at whatever size they find themselves. We can take
people at any weight and look at them holistically—considering
mind, body, and spirit, and help them to be healthier no matter
how much they weigh. If we can help people work on mind,
body, and spirit, it’s very likely that their weight will come to a
level that’s healthy for them.
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There’s another important piece to mention here. When it
comes to taking a holistic perspective on obesity and weight
gain, we’ve got to be sure we’re asking the right questions. With
obesity, we’ve come up with lots of answers, but they’re answers
to the wrong questions. The fast food industry serves as a good
example. As health professionals, we’re trying to answer the
question, “How do we get people to eat less fast food?” What
are our answers? Currently, we are bad-mouthing it, considering
taking it out of the schools, taxing it, etc. It’s never going to
work. These are the wrong answers.
But tragically, these wrong answers are not even to the right
question. The question we ought to be asking is, “What is it
about the culture that has created the demand for fast food
restaurants?” If you ask that question, people really start to
think. They have to say, “Well let’s see. I’m not spending time
with my family cooking and eating healthy meals because I’m
working extra hours to pay for my trophy home and my brand
new SUV.”
I realize that answer is true for only part of the population. The
other part of the population is saying, “Wait a minute. I have to
work two jobs just to make ends meet. Fast food is a necessary
time saver for me.” Either way, both situations create the demand
for fast food. These answers are much more difficult to address,
but at least they’re the product of the right question.
I’ve heard you say that health promotion is not
about prevention. That may surprise some people.
What do you mean by that?
ROBISON: I believe we ought to be focusing most of our efforts
not on trying to prevent death and disease, but on trying to
promote and enhance wellness. We should be trying to enhance
peoples’ health and their ability to make better choices for
themselves. Prevention has not been a very successful tool at all
because it’s the wrong focus. We need to help people to decide
for themselves what they think brings a good and healthy life
instead of beating them over the head with what we think they
should be doing. It’s like teaching people to fish rather than giving them a fish dinner.
Any final words, Jon?
ROBISON: I know that Holistic Health Promotion can be very
intimidating at first for traditionally trained health promotion
professionals. It certainly was for me when I was first introduced
to it. Nobody had ever talked to me about dealing with people’s
feelings. Certainly nobody ever talked to me about considering
their spiritual inclinations.
So when people are first introduced to Holistic Health
Promotion it can be scary. They tend to say, “Gee, I’m not a
psychologist. I’m not a chaplain. How the heck do I talk to
these people about this?” Well the truth is, we’re all capable of
2004 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG
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©2004 Wellness Councils of America. Visit our website at www.welcoa.org.
WELCOA
“Science is always changing,
and the science upon which
we predicated our understanding
of human health and human
behavior has evolved tremendously
in the last 100 years.
Many of us—physicians,
nurses, dieticians, exercise
physiologists, health educators,
social workers, psychologists,
etc.—are really behind the times.
We need to catch up because
we’re missing a lot.”
helping people in this way. I believe health promotion is primarily a spiritual endeavor. It’s about helping people feel better
about themselves, and helping them to discover meaning and
purpose in life. These are all spiritual things.
So you don’t have to be a psychologist; you don’t have to be a
chaplain. What you have to be is a licensed human being. I
believe all of us can do that because we went into this profession
in the first place to help people. We already have the compassion we need, it just needs to be cultivated, and we need to
learn the skills and tools to use it. There’s going to be a need for
some retraining, but it’s training in the right direction. It’s training for the future, and it’s training in what can truly help people
heal and grow.
This interview was conducted on 02/16/04 and released on 05/01/04.
All information © Wellness Councils of America (WELCOA) 2004.
WELCOA provides worksite wellness products, services, and information to
thousands of organizations nationwide. For more information visit
www.welcoa.org.
Suggested Citation: Robison, J. (2004). Big Picture Thinking. WELCOA’s Absolute Advantage Magazine, 3(7), 32-37.
2004 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG
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ABSOLUTE ADVANTAGE
©2004 Wellness Councils of America. Visit our website at www.welcoa.org.
| 37
ABSOLUTE ADVANTAGE
Products and services to help you build
a Holistic Health Promotion program that gets results.
By Jon Robison, PhD, MS, and Kelly Putnam, MA
I
If you’re looking for some assistance in building a quality Holistic Health Promotion program, there are
some excellent resources available. Check out the following products and services available from this
month’s guest editor, Jon Robison, PhD and the staff at Kailo (see case study on page 20).
The resources listed here are reliable, refined, and incorporate many of the aspects of Holistic Health
Promotion discussed in the pages of this magazine. Best of all, they come from experts in the field—
health promotion professionals that are well-versed in building holistic programs from the ground up.
Take a look, and don’t hesitate to contact these experts in the field as you move forward in building your
Holistic Health Promotion program.
Consulting Services
Holistic Health Promotion Certification Program
Dr. Robison and the Kailo team are eager to help your organization “go holistic.” Dr. Robison’s extensive knowledge of the science
and theory behind the holistic approach to health promotion
combined with Kailo’s expertise in implementing the approach in
a real-world setting, make for a valuable consulting team. Whether
it’s by phone or in person, as a team or individually, Dr. Robison
and Kailo will happily flex to meet your needs. For more information about consulting services contact Dr. Robison at (517)
347-6016 or visit www.jonrobison.net. You may also call Kelly
Putnam at Kailo by dialing (641) 422-7141.
This program is a 16-hour (two-day) comprehensive training in
the science, theory, and practice of Holistic Health Promotion presented by Jon Robison, PhD, Kelly Putnam, MA, and Laura
McKibbin, LISW. The program is perfect for health promotion
staff, organizational leaders, wellness committee members, occupational health practitioners, EAP providers, and anyone
interested in deepening their understanding of promoting health
and well-being in the workplace. For more information about the
Holistic Health Promotion Certificate Program, call Dr. Robison
at (517) 347-6016 or visit www.jonrobison.net.
38 |
ABSOLUTE ADVANTAGE
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©2004 Wellness Councils of America. Visit our website at www.welcoa.org.
WELCOA
Kailo Sister Program
You can replicate the best practice in holistic worksite health promotion by becoming
a “Kailo Sister Program.” By purchasing the
rights to the Kailo name, logo, marketing,
and program materials, your organization
will be able to implement a world-class
wellness initiative at a fraction of what it
would cost to build a comparable program
from scratch. For more information, call
Kelly Putnam at (641) 422-7141.
The Kailo-To-Go pre-packaged
programs are perfect for busy
health promotion professionals.
Speaking
Dr. Robison’s thoroughly researched presentations and passionate delivery make him a
dynamic speaker for professional and lay
audiences alike. He is a frequent presenter at
national gatherings including the National
Wellness Conference, the American Journal
of Health Promotion Conference, the Association for Worksite Health Promotion
Conference, and the American Occupational Health Conference.
For more information on speaker topics
and fees, call Dr. Robison at (517) 2476016 or visit www.jonrobison.net.
Kelly Putnam, MA and Laura McKibbin, LISW are frequent presenters at
regional and national conferences for health
and wellness promoters, healthcare executives, employee assistance providers, human
resources professionals, and occupational
health practitioners. Topics include, Implementing a Holistic Approach to Health
Promotion in the Workplace; Addressing
Employee Depression; and Integrating Health
Promotion with Employee Assistance Programs, Occupational Health Initiatives, and
Leadership Development.
Publications
If you’re looking for the book on the holistic approach to health promotion, this is it!
The Spirit and Science of Holistic Health:
More Than Broccoli, Jogging, and Bottled
Water…More Than Yoga, Herbs, and Meditation was written by Jon Robison, PhD
and Karen Carrier, MEd, to assist health
promotion professionals in understanding
the holistic approach to improving health.
In the book, it is proposed that the major
health problems in the United States are not
heart disease, cancer, osteoporosis, or obesity.
Instead, they are about violence, prejudice,
social isolation, and runaway materialism.
Unfortunately, traditional health promotion
continues to “attack” our problems by
declaring war on disease, obsessing about
Depression Kit and Healthy Sleep Kit are
excellent choices.
The new book by Jon Robison, PhD,
MS, and Karen Carrier, MEd, provides health promotion professionals
with a clear view of what Holistic
Health Promotion is all about.
epidemiologically-based risk factors, and
frightening people about what they eat, how
much they weigh, and what they like to do
or not do. These approaches rarely help, and
often create an atmosphere of anxiety and
confusion.
This book is an invitation to health professionals to rethink their current
understanding of health, illness, and the
process of healing. It covers topics that are
rarely addressed in health promotion
including the history of the human species,
the Scientific Revolution, quantum physics,
and the latest mind-body-spirit research.
While it may seem that this information is
only marginally related to health, it provides a critical foundation for the truly
holistic approach to health promotion.
The book is published by AuthorHouse,
and retails for $23.95 (softcover) or
$31.50 (hardcover). To order, call 888280-7715 or visit www.authorhouse.com.
Kailo-To-Go
Pre-Packaged Programs
Based on the Kailo philosophy and successfully road-tested with employees at
Mercy Medical Center - North Iowa, these
ready-to-deliver wellness education and
awareness kits are perfect for busy worksite
health promoters, occupational health
practitioners, human resources professionals, and EAP providers. The Kailo-To-Go
2004 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG
©
• Kailo-To-Go Depression Kit—
Employee depression is one of
the most prevalent, costly, and
highly treatable health issues in
the workplace. Yet, most organizations remain unresponsive.
The Kailo-To-Go Depression
Kit includes separate PowerPoint
lunch ‘n learn presentations for
managers and employees, marketing materials, newsletter and
e-mail copy, evaluation tools,
wrap-up video, and more to help
your organization be more
proactive in addressing workplace depression.
• Kailo-To-Go Healthy Sleep
Kit—Over 70 percent of Americans get less than eight hours of
sleep per night, which means
most of your employees are
probably meeting the definition
for clinical sleep deprivation!
The Kailo-To-Go Healthy Sleep
Kit includes a PowerPoint lunch
‘n learn presentation, marketing
materials, newsletter and e-mail
copy, evaluation tools, and more
to help you educate your
employees about the role of sleep
in their overall health and wellbeing and provide tips for how
to enhance the quantity and
quality of their ZZZZ-time.
For more information on Kailo-To-Go Kits
or to place an order, visit www.kailo.org.
All information © Wellness Councils
of America (WELCOA) 2004.
WELCOA provides worksite wellness products, services, and information to thousands
of organizations nationwide. For more information visit
www.welcoa.org.
Suggested Citation: Robison, J., & Putnam, K. (2004).
Going Holistic. WELCOA’s Absolute Advantage Magazine, 3(7), 38-39.
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| 39
ABSOLUTE ADVANTAGE
40 |
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ABSOLUTE ADVANTAGE
| 41
ABSOLUTE ADVANTAGE
I
In this issue of Absolute Advantage we have provided a rationale
and suggestions for shifting organizational health promotion programs from biomedical to holistic approaches. However, much of
what affects the health of individuals occurs outside of the confines of organized wellness programs. For example, it is certainly
important for worksite health professionals to be aware of the
ways in which mind-body-spirit research helps us to understand
the emotional issues that underlie asthma attacks. We must also
be aware, however, that close to a quarter of the mostly poor,
black children in West Harlem now suffer from asthma. This is
four times the national average and is likely related to the fact that
they live in an area that is home to 2,400 diesel buses and six of
the city’s seven diesel bus depots.1 Moreover, living in substandard
housing filled with mold and other allergens can only exacerbate
their condition. Clearly, not even well-thought-out worksite
interventions that include families and dependents can help these
children if nothing is done about the economic and political environment that perpetuates these living conditions.
The tendency to ignore the less measurable but more fundamental
causes of people’s suffering is a legacy of the 17th century mechanistic
worldview and the resulting biomedical focus of healthcare that was
discussed earlier in this issue. Thus, for example, it is also not surprising that most of the research conducted to date on health
differences between the races has focused on genetic and biological explanations. Now, a growing body of research suggests that
many of these health disparities may lie with less such measurable
factors as racial prejudice and discrimination.2,3
Unfortunately, this legacy holds sway when it comes to worksite health promotion as well, where the overwhelming focus on
measurable, biomedical risk factors has often obscured the more
fundamental causes of ill health and medical claims. A good
example can be found in back injuries, which cause a tremendous
amount of suffering and are responsible for a substantial proportion of medical costs for many organizations. In spite of
traditional wisdom to the contrary, it turns out that the factors
that are most predictive of work-related back injury claims are not
physical factors at all, but rather worker satisfaction and other less
tangible psychosocial issues.4 In fact, recent research has shown
that psychosocial factors such as depression and stress are the
leading predictors of healthcare expenditures at the workplace.5
“To be able to listen without judgment and
connect compassionately with a suffering
human being is a different matter altogether—
one that requires a much deeper level of
self-awareness and growth.”
42 |
ABSOLUTE ADVANTAGE
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WELCOA
“In order to help people focus
on the real and exceedingly
complex underlying issues
affecting their health, it is
imperative that worksite health
professionals embrace the
phenomenon. The weights of populations throughout the world
are increasing as societies become more affluent and less mobile.
Instead of patiently and compassionately exploring the extremely
complex roots of this phenomenon, governments and health
experts have chosen to focus on old paradigm, simplistic, quickfix, control-oriented solutions; suing fast-food restaurants,
mandating the use of pedometers, sending children home from
school with notes saying they are too fat, and recommending surgeries that result in permanent mutilation of people’s inner organs
in the name of health.
In our ever-shrinking, interconnected world these types of interventions are destined to fail. They arise out of a clearly outdated
mechanistic, reductionist, scientific worldview that ignores the
realities of the complex web of life of which we are a part. In the
long run, we will not force people to live the way we think they
should, and our continued efforts to do so are likely to backfire,
causing people to feel even more confused and anxious about their
lives and their health than they already do.
Shifting The Paradigm
new sciences and the new
understandings about human
behavior and the underlying
causes of health and illness.”
A Matter Of Culture
It is also important to remember that, even when we believe we
are doing the right thing, social and political policies can often
lead us astray. Our culture is to be applauded for finally standing
up to the big tobacco companies and forcing them to stop marketing their products to children, who then become lifelong
customers. However, at the same time we are failing to stand up
to the pharmaceutical companies and the health establishment
when they aggressively market Ritalin, Adderall, and other stimulants to parents and their children. Recent studies suggest that as
many as 10 percent of school-age children (who once again may
become lifelong customers) are being prescribed these powerful,
psychiatric drugs. In some parts of the country, this number is as
high as 20 percent among boys, who are more likely to act out in
the classroom.6
As a culture, we find it easier to pathologize these children and
control them with psycho-stimulants than to fund development of
flexible and creative educational environments and parental
support programs that can nurture children with normal, yet
diverse behavioral needs. Much the same can be said about our
approaches to helping people with weight and eating-related concerns. Once again, our disease-focused, biomedically-oriented
worldview leads us to pathologize what is clearly a socio-cultural
2004 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG
©
In order to help people focus on the real and exceedingly complex
underlying issues affecting their health, it is imperative that worksite health professionals embrace the new sciences and the new
understandings about human behavior and the underlying causes
of health and illness. The list of suggested readings provided on
page 44 of this issue will go a long way towards providing the
background information to help with this process. Though much
of the information contained within these books is not typically
included in health promotion curricula, it is essential for understanding the all important context in which people’s health beliefs
and behaviors are embedded.
Though moving in this holistic direction is often considered
soft, unscientific, and quite un-business-like, it is actually consistent with recent work in organizational development, which views
organizations as complex, dynamic entities that are much more
like living beings than they are like huge machines. Applying the
new scientific understandings from psychoneuroimmunology,
quantum physics, and chaos theory can help improve the health of
these large entities, as well as the health of the smaller entities of
which they consist.7
An Ounce Of Perspective
As important as the kinds of issues typically addressed in worksite
health promotion programs are, they pale in comparison to the
struggles afflicting people in other parts of the world and even
many Americans here at home. Most traditional health promotion
interventions are barely relevant for people who live where famine,
AIDS, war, and terrorism are the order of the day. We must
remember that in some parts of the world it is not even considered
a crime to rape or murder a woman or a child. Indeed, in many
places women, who are still considered to be the property of men,
are unable to obtain an education, vote, work, own resources, or
participate in society in any meaningful way.8 Even here in
America, the richest country in the world, proclaiming obesity as
the nations’ number one (or even number two) health problem
borders on the absurd when we understand that some 12 million
children live below the poverty line and that almost 50 percent of
ABSOLUTE ADVANTAGE
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| 43
ABSOLUTE ADVANTAGE
low-income, full-time workers have no health insurance.9,10
We may find ourselves thinking that as health professionals we
can do nothing to address social injustice and world problems.
This is not true. We can all make a difference. Whether it is
getting involved with activist organizations or simply listening
without judgment when someone comes to us concerned about
her or his blood pressure or weight, we can make a difference that
contributes to the emergence of more peaceful, just, and truly
health-promoting cultures.
What Really Helps?
This brings us to perhaps the most fundamental and important
question concerning the role of health promoters, a question
whose answer illuminates one of the most basic distinctions
between traditional and holistic approaches to health promotion.
Is it what we do or who we are that is the most critical component
of helping people to grow and heal? In his powerful book, How
Can I Help: Reflections, Ram Dass answers this question most powerfully when he states:
“We can of course help through all that we do but at the deepest
level we help through who we are.”11
The ramifications of this conclusion are immense. In order to
work effectively in Holistic Health Promotion, we must be aware
of our own issues. In traditional health promotion approaches this
is simply not necessary. We do not need to work on our own issues
in order to take a skinfold, write a behavioral contract, assign
someone to a stage of change, or prescribe a diet or exercise
regimen. But to be able to listen without judgment and connect
compassionately with a suffering human being is a different matter
altogether—one that requires a much deeper level of self-awareness and growth.
If we try to listen to and support others without actively
working on our own issues, we are at risk for what Jacquelyn
Small, author of Becoming Naturally Therapeutic, calls “toxic relating.”12 Small explains that:
“Toxic relating happens when a listener acts out of his or her
own unmet needs and confuses them with those of the person
seeking help. This lack of clarity will throw the “helper” into a role
that can harm the very person seeking help. Those finding themselves in such a situation will usually resort to a role such as
preacher, judge, teacher, or savior.”
We believe that, for health professionals, doing our own work is
the most important prerequisite for helping others to heal and
grow. We believe that the same holds true for healing on a global
level. While there are many avenues for helping available to all of
us, perhaps the most powerful route to change is suggested by
Wayne Muller in his book Sabbath.13
“Ultimately, we have just one moral duty: to reclaim large areas
of peace in ourselves, more and more peace, and reflect it towards
others. The more peace there is in us, the more peace there will
also be in our troubled world.”
All information © Wellness Councils of America (WELCOA) 2004.
WELCOA provides worksite wellness products, services, and information to
thousands of organizations nationwide. For more information visit
www.welcoa.org.
Suggested Citation: Robison, J. (2004). A New Day. WELCOA’s Absolute Advantage Magazine, 3(7), 40-44.
44 |
ABSOLUTE ADVANTAGE
Holistic Health Promotion — Top Ten Reading List
1. Capra, F. The Turning Point: Science, Society, and The Rising Culture.
Bantam, Toronto, 1983.
2. Ornstein, R. & Sobel, D. Healthy Pleasures. Addison-Wesley, Reading,
Massachusetts, 1989.
3. Eisler, R. The Chalice and The Blade: Our History, Our Future. Harper,
San Fransisco, 1987,1995.
4. Kohn, A. Punished By Rewards: The Trouble with Gold Stars, Incentive
Plans, A’s, Praise and Other Bribes. Houghton Mifflin, Boston, 1993.
5. Buckingham M, Coffman C. First, Break All The Rules: What The
World’s Greatest Managers Do Differently. Simon & Schuster, New
York, 1999.
6. Ornish D. Love and Survival: The Scientific Basis For The Healing
Power of Intimacy. Harper Collins Publishers, New York, 1998.
7. Wheatley, MJ. Leadership and the New Science: Learning about Organization from an Orderly Universe. Berrett-Koehler Publishers, San
Francisco, 1992.
8. Dass R, Gorman P. How Can I Help: Stories and Reflections on Service.
Alfred A Knopf Inc., New York, 1993.
9. Buchanan, D. An Ethic For Health Promotion: Rethinking The Sources
of Human Well-Being. Oxford University Press, New York, 2000.
10. Robison, J., Carrier, K. The Spirit and Science of Holistic Health: More
Than Broccoli, Jogging and Bottled Water…More Than Yoga, Herbs
and Meditation. AuthorHouse, 2004.
References
1. West Harlem Environmental Action Inc. (WE ACT), 271 West 125th
Street, Suite 308, New York, NY 10027–4424. e-mail www.weact.org
2. Williams, D. R. Race and Health: Basic Questions, Emerging Directions. Ann Epidemiol 7, no. 5 (July 1997): 322-33.
3. Mckenzie, K. Racism and Health. Student British Medical Journal 11
(2003):2–3.
4. Bigos, S., Battie, M., Spengler, et. al., A Prospective Study of Work Perceptions and Psychosocial Factors Affecting the Report of Back Injury.
Spine 1991;16(1):1-6.
5. Goetzel, R., Anderson, D., Whitmer, R. et. al., The Relationship Between
Modifiable Health Risks and Health Care Expenditures: An Analysis of
the Multi-Employer Hero Health Risk and Cost Database. Journal of
Occupational and Environmental Medicine 1998;40(10):843-854.
6. Breggin, P. R. Talking Back to Ritalin: What Doctor’s Aren’t Telling You
about Stimulants and ADHD. Cambridge, MA: Perseus, 2001.
7. Wheatley, MJ. Leadership and the New Science: Learning about Organization from an Orderly Universe. Berrett-Koehler Publishers, San
Francisco, 1992.
8. World Health Organization. World report on violence and health,
October 2002. ISBN 9–241–54561–5. e-mail: [email protected]
9. National Center for Children in Poverty. http://www.nccp.org/
pub_cpf03.html
10. Who is Most Likely To Be Uninsured? Employee Benefit Research
Institute Estimates from the March Current Population Survey, 2001
Supplement. http://covertheuninsuredweek.org/factsheets/display.
php?FactSheetID=26.
11. Dass R, Gorman P. How Can I Help: Stories and Reflections on Service.
Alfred A Knopf Inc.,New York, 1993.
12. Small J. Becoming Naturally Therapeutic: A Return to the True Essence
of Helping. New York: Bantam, 1990.
13. Muller, Wayne. Sabbath: Finding Rest, Renewal, and Delight in Our
Busy Lives. New York: Bantam, 2000.
2004 WELLNESS COUNCILS OF AMERICA | WWW.WELCOA.ORG
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©2004 Wellness Councils of America. Visit our website at www.welcoa.org.
WELCOA
Reinventing
Health Promotion...
call 8To order,
88-28
o
r visit0-7715
www
.a
uthor
hous
e.com
For the Modern Age
The new book by
Jon Robison, PhD, MS
and Karen Carrier, MEd
The Spirit and Science
of Holistic Health is
now available!
or too long, health promotion has focused solely on
risk factors for disease, instead of the all-important
supportive factors for health and the interconnected nature of health and healing. In their new book,
The Spirit and Science of Holistic Health, Jon Robison
and Karen Carrier provide a definitive look at Holistic
Health Promotion and offer a rationale for reinventing
health promotion in the modern age. Topics covered in
the book include:
F
•
•
•
•
•
Holistic vs.the biomedical approach to health promotion
The history of the human species
Quantum physics and the human body
The latest in mind-body-spirit research
Practical tips and strategies to help you build a
Holistic Health Promotion Program that gets results
Don’t miss your opportunity to get the best information
available about Holistic Health Promotion.
Order Today!
Contact Dr. Jon Robison
517-347-6016 • www.jonrobison.net • [email protected]
“This book is a refreshing
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today’s health hucksters.
It’s an in-depth look at the
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to achieve it, in all its
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The Spirit and Science of
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This book should be
tattooed on the brain
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professional in the land.”
-Larry Dossey, MD
Author,
Healing Beyond The Body,
Reinventing Medicine, and
Healing Words
©2004 Wellness Councils of America. Visit our website at www.welcoa.org.
ABSOLUTE ADVANTAGE
TABLE OF CONTENTS
Toward A
New Science
Holistic Health Promotion connects
the spiritual, biological, psychological, and social dimensions of health
for a true understanding of health
and healing. Find out what Holistic
Health Promotion is all about and
learn why it matters to modern
health promotion professionals.
ABSOLUTE ADVANTAGE
UP NEXT...
The CHIP Program
For years, CHIP (the Coronary Health Improvement Project) has been
helping people markedly reduce coronary risk factor levels through
the adoption of better health habits and appropriate lifestyle
changes. In the next issue of Absolute Advantage, Guest Editor and
CHIP Founder Dr. Hans Diehl will outline the CHIP program in detail
and share individual and community success stories from all across
the United States.
Page 2
6
Reinventing The Profession
Incorporating a holistic approach into your program will mean
rethinking (and rebuilding) some of your current offerings. Here’s a
primer in what you’ll need to do and how you’ll need to do it.
| By Jon Robison, PhD, MS
12
The Path To Spiritual Wellness
Addressing spirituality in health promotion may seem akin to beating
a bee hive with a stick—you’re liable to get stung. It doesn’t have to
be this way. Stress management programs offer a unique opportunity
to delve into spiritual well-being with trust and openness.
| By Brian Luke Seaward, PhD
16
With more than 40,000 graduates worldwide, and results published
in the Journal of Occupational and Environmental Medicine, CHIP is
getting noticed. Don’t miss out on the opportunity to get involved in
the CHIP program, and get an in-depth look at this unique and powerful initiative in the next issue of Absolute Advantage!
Seeing Things Through Different Eyes
There’s a real difference between the biomedical and holistic
approaches when it comes to helping employees deal with health
risks. Get a clear perspective on how Holistic Health Promotion differs
from the traditional approach in this article.
| By Karen Carrier, MEd
20
The Kailo Concept
Using a non-traditional, holistic wellness program that focuses on
overall wellness, life satisfaction, and job engagement, Mercy Medical
Center - North Iowa has created a program that achieves results.
| By Kelly Putnam, MA
26
Holistic Health, Inc.
Can Holistic Health Promotion really fit within the confines of traditional corporate culture? Will spiritual connections ever be mentioned
in the same breath as yearly financials? It’s time to find out.
| By Walter S. Elias, PhD
32
Big Picture Thinking
This month’s Guest Editor Jon Robison, PhD, MS, discusses how you
can prepare yourself to meet the challenges of addressing employee
health holistically. | INTERVIEW with Jon Robison, PhD, MS
38
Going Holistic
If you’re looking for some help in building a Holistic Health Promotion
program, there are several tools and resources at your disposal. This
article will get you started in the right direction.
| By Jon Robison, PhD, MS and Kelly Putnam, MA
40
A New Day
So what does the future hold for Holistic Health Promotion? The
answer lies in answering the question, “Is it what we do or who we
are that is the most critical component of helping people grow and
heal?” | By Jon Robison, PhD, MS
ABOUT THE
WELLNESS COUNCILS OF AMERICA
The Wellness Councils of America is one of North
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WELCOA is widely recognized and highly regarded for its innovative approach to worksite wellness.
Indeed, through their internationally recognized
“Well Workplace” awards initiative, WELCOA has
helped hundreds of companies transform their corporate cultures and improve the health and wellbeing of their most valuable asset—their employees.
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