Sick of SickCare?

The Big Secret ---

Whole Population

Wellbeing Maximization

Dr Roger Jahnke, OMD

Health Action Synergies

http:HealthAction.net

Fast Paced

Email questions and requests:

DrJahnke@HealthAction.net

Slides will be posted

70% of disease is preventable

Healthy People 2000, DHHS, 1991, #91-50213 National Center For Health Statistics, DHHS, 1992, # 92-1232

8 of 9causes of disease are

Preventable (90%)

New England Journal of Medicine, Fries, Koop, et al, 329:321-325, 7/93

StrikingProjection

Kaiser Family Foundation

2012 = $3 trillion

Industry Watch• AMA• AHA/VHA• NWI, NHWP Congress• Air Force, Veteran’s Administration • YMCA, Fitness, Medical Fitness• IHPM• Numerous hospital systems• Publications - numerous articles in

journals and chapters in texts

Distillation of Findings

Integrative Medicine &

Mind Body Wellness

Coaching:Health, Wellness,Life

Mind-Body Practice

What is at stakeMONEY $$• $2,100,000,000,000 - $2,800,000,000,000• “Conventional” medicine is programmed to keep

the $3 T, AND, until very recently hardly anybody has been going for the $2.1 -- $2.8 T

MISSION• National Financial Bailout• Health Patriotism• Recovery of Citizen Self - Reliance

CONTINUUM

Health Coach

Informed Citizen

Disease Intervention

Wellbeing Maximization

Hospice

Self-Managed Care

Physician

NEXUS

Health Self-Reliant Citizen

Medically Managed Care

HealthcareOld Paradigm:

To clinically assess risk and render clinical procedures to reduce pathology.

Pathology based, institutionally based (hospital, clinic), extremely expensive, does not foster citizen self- reliance.

Health CareNew Paradigm:

To behaviorally sustain and enhance health through personal action.

Health based, community based (home, fitness center, workplace, school), less expensive, fosters health self-reliance.

Conventional Healthcare

The Public

Consultation

Diagnosis

Treatment

WellnessMedicine

Self Inquiry

Personal Plan

Personal Action

Group Support

HealthPromotion

Consultation

Diagnosis

Treatment

ConventionalMedicine

Genuine Health Care

The Public

Consultation

Diagnosis

Treatment

WellnessMedicine

Self Inquiry

Personal Plan

Personal Action

Group Support

Mind-BodySelf-Care

Consultation

Diagnosis

Treatment

ConventionalMedicine

Risk and Cost

$3.93

$5.07$5.93

$5.81

ROI Wellness ProgramsPelletier,Eddington, Goetzel, etc.E

• Heart disease• Cancer• Stroke• COPD, pneumonia

& flu• Accidents • Diabetes• Suicide• Kidney disease• Liver disease

Conventional

10LeadingCauses of DeathNational Vital Statistics Report, Volume 53, Number 5

• Tobacco

• Diet/activity patterns

• Alcohol

• Microbial agents

• Toxic agents

• Firearms

• Sexual behavior

• Motor vehicles

• Illicit use of drugs

Sea Change- -

9ActualCauses of DeathJournal of the American Medical Association,

McGinnis and Foege, 270:2207-2212, 11/93

Recent ResearchGlobal Epidemiology

The Lancet – July 2012Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy

I-Min Lee, Eric J Shiroma, Felipe Lobelo, Pekka Puska,

Steven N Blair, Peter T Katzmarzyk

“Danger of inactivity is equal to danger of tobacco use!”

• Lack of information and healthful lifestyle skills

• Compromised self-efficacy• External & internal stress• Low self-esteem• Mis-information about

necessity of medical expertise

• Anger and frustration• Disempowered, fear

driven • Economic disparity• Confusion – No Plan

Sea Change+- -

8RootCauses of DeathHealth Action, Inc., 1999, 2002, 2007, 2011,

2012

Mind-BodyParadigm

Golden KeysRelaxation Response

vs Stress Response=

Behavioral Prevention

Coaching Mind-Body Practice

Mind-BodyPractice

•

Tai ChiQigongYoga

Mindfulness

Recent ResearchAmerican Journal of

Health Promotion (AJHP)

A Comprehensive Review of the Health Benefits of Qigong and Tai Chi

AJHP, Jahnke, Larkey, 6/2010

9 Health Outcomes

0 5 10 15 20 25 30

Psychological

Immune Function and Inflammation

Quality of Life

Falls Prevention and Balance

Osteoporosis

Immune Function

Patient Reported Outcomes

Self-efficacy

Cardio Pulmonary Effects

Neuro - Psychological

Compelling Findings

• Primary Killer – Heart & Cardiovascular

• 19 of the studies found Qigong and Tai Chi safe and effective in the treatment of the greatest killing disease

Compelling Findings

• Neuro – Psychological• The most devastating non-killing

diseases – stress, anxiety, depression.• 27 studies found Qigong and Tai Chi

safe and effective.

Compelling Findings

• Balance and Falls Prevention• Among the most expensive

preventable diseases.• 24 studies found Qigong and Tai Chi

safe and effective.

Lancet1st paragraph, 1st sentence

“Ancient physicians—including those from China in 2600 BC and Hippocrates around 400 BC—believed in the value of physical activity for health. By the 20th century, however, a diametrically opposite view—that exercise was dangerous—prevailed instead.”

Physiological Mechanisms

• Oxygen delivery• Acceleration of water–lymph• Autonomic balance• Neuro-transmitter shift • Immune function

Relaxation Response (RR)

• Shift Autonomic – Sympathetic > Parasympathetic

• Adrenergic NT > Cholinergic NT• Hypertensive > Normotensive• Intrinsic Lympahtic ++• Immune Function ++

RR & Gene Expression

• Benson Team - Genomic counter-stress changes induced by the relaxation response 2008 Jul 2;3(7):e2576

• Li Team - Genomic profiling in Asian Qigong practitioners: gene regulation by mind-body interaction. Journal of Alternative and Complement Medicine 2005 Feb;11(1):29-39

• Sharma Team - Gene expression profiling in practitioners of Sudarshan Kriya Journal of Psychosomatic Research 2008 Feb;64(2):213-8

RR & Gene Expression

“It is becoming increasingly clear that psychosocial stress can manifest as system-wide perturbations of cellular processes, generally increasing oxidative stress and promoting a pro-inflammatory milieu. More recently, chronic psychosocial stress has been associated with accelerated aging at the cellular level. Specifically, shortened telomeres, low telomerase activity, decreased anti-oxidant capacity and increased oxidative stress are correlated with increased psychosocial stress and with increased vulnerability to a variety of disease states.”

Mind-Body Practice=

Reduced rate of cell death

Longevity and

Anti-Aging

Fountain of Youth

Sample Programs- Tai Chi Easy

- Mind-Body Max

• 1000 Practice Leaders Trained• Fitness, spa, community center,

hospital, corporation, school, social service, faith, military

Coaching

HealthWellness

Life

Empowerment Zones• Nutrition

• Exercise• Stress Mastery• Relationships• Finances• Work• Play• Health Care• Environment• Purpose• Self-Esteem• Spirit

The CoL Process• Circle of Life Self-Assessment, 12 areas of Life – Empowerment Zones.

• Acknowledge Strengths

• Group Based Cost Efficiencies

• Blueprint for Success - Acknowledge Victories, Assets- Create Targeted Intentions- Set clear SMART Goals- Recognize Challenges- Target Action Steps- Schedule Action Steps- Mind-Body Self-Care Practices- Accountability

Recent ResearchHealth Coaching

UC Santa BarbaraDepartment of Economics

A Group-based Wellness Intervention in the Laboratory:Economic Implications of Health Coaching

Drs Charness and JahnkeB.E. Journal of Economic Analysis & Policy

March, 2012

3 Compelling Findings

1. Participants learned to slow their heart rate – control could not.2. Participants, with no specific instruction, increased weekly exercise by +36min, control decreased -5 min.3. By simply slowing the heart rate (stress mastery) and increasing physical activity (added weekly exercise), $9.5 billion could be saved annually in prevented heart attacks alone.

DeliveryWith Coach

Self-Directed

Live solo

Web Wizard

Live group

Phone solo

Live group

Coach -Assisted

POWERS OF THEWEB WIZARD

• Ubiquitous access – facility, home, mobile, workstation• Marketing – both pre and post member• Social net working• Integrated with the electronic medical record• Robust research potential

CONCLUDING

Good NewsTax and Premium Incentives

“The Affordable Care Act raises the maximum allowed size of wellness incentives, which will lead to differences in insurance premiums between users and nonusers of programs.”&“The Affordable Care Act expands the ability of employers to reward workers who achieve health improvement goals.”

ConfoundingEvidence based (EB) programs and best practices – -- when a particular program in a category is “proven”, it is like

advertising for just one program that does what many programs can do, do well and do safely.

-- when a best practice is declared, exploration and innovation can tend to be curtailed.

-- when a program reaches “evidence based” status – consider the concept as it may be presented in alternative programs.

Recommendation – when a programmatic concept is found safe and effective, it is not necessarily true that the only acceptable program is the one that was the basis for the evidence.

ScalingIt is obvious that the mind-body paradigm – Coaching and Mind-Body Practice -- implemented in the group based delivery context, can scale in great magnitude allowing the nexus of health care to be health maximization focused in schools, fitness centers, YMCAs, social service agencies, faith based ministries, the military and VA, corporations, professional associations and unions as well as hospitals and clinics.

Fun Questions• Is the future of health care financing in

the diagnosis of preventable diseases and medical intervention solutions?

OR• Is the future of health care financing in

the reallocation of the $3 trillion to wellbeing maximization?

BETTER QUESTION –How will this happen?

Does health maximization happen in clinics and hospitals?

ORDoes health maximization happen

at home, work, school, social service agency, faith ministry, fitness center?

PREDICTIONThis is simple logic:

If 70% - 90% of disease is preventable ---

• The nexus of all health care activity will not be the clinic and the hospital.

• The $3 trillion will not be going to medicine & medical intervention.

R U Ready?Already Involved?

Health Action Synergies

HealthAction.netDrJahnke@HealthAction.ne

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