Defining Health in a Comprehensive Context: A New Definition of Integrative Health.

Abstract

CURRENT ISSUES Defining Health in a Comprehensive Context: A New Definition of Integrative Health Claudia M. Witt, MD, MBA, 1,2 Delia Chiaramonte, MD, 1 Susan Berman, BA, 3 Margaret A. Chesney, PhD, 4 George A. Kaplan, PhD, 5 Kurt C. Stange, MD, PhD, 6 Steven H. Woolf, MD, MPH, 7 Brian M. Berman, MD 1,3 INTRODUCTION D espite investments in health care, good health remains elusive for many people. Healthcare systems generally are disease-focused and con- centrate resources on treatment modalities that often work well for acute or life-threatening illnesses such as physical trauma or infectious disease, but sometimes are poorly suited to the management of chronic illness. 1–3 Modifying the healthcare system to recognize the impor- tance of social, behavioral, economic, and environmental determinants of health might better address current population needs. 4–6 Such changes face many challenges, but a fundamental step is to incorporate emerging concepts such as integrative medicine and social deter- minants of health in order to create a working definition of integrative health. Creating a more inclusive definition could support strategic planning of initiatives promoting health across multiple sectors of daily life, not just the clinic. In 1948, WHO defined health as: “… a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” 7 Although this definition has positive elements that have kept it in active use for decades, it has significant shortcomings that limit its usefulness. For example, Huber et al. 8 noted that WHO’s emphasis on “complete” well-being fails to capture the longevity and high functioning of many individuals living with chronic conditions and disabilities. With the contemporary shifts in health care that focus increasingly on wellness, health management across the lifespan, patient-centeredness, evidence-based medicine, and the integration of complementary medicine, “inte- grative medicine” is a term that is increasingly used to describe healthcare interventions. 9 For example, integra- tive medicine has been defined by the Academic Con- sortium for Integrative Medicine and Health (previously named the Consortium of Academic Health Centers for Integrative Medicine) as, “the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appro- priate therapeutic and lifestyle approaches, healthcare professionals and disciplines to achieve optimal health and healing.” 10 Though care delivered in the clinical setting is impor- tant to health and wellness, it is only one factor among multiple determinants of health—for individuals, com- munities, or populations. 11 Thus, it is helpful to differ- entiate between integrative medicine and integrative health. A broader notion of health that expands “beyond the clinic” is establishing itself not only in medicine but in society at large. For example, HRH The Prince of Wales recently wrote about integrative health, adding that it “represents an approach to individual and population health which respects and includes all health related areas, such as the physical and social environ- ment, education, agriculture and architecture.” 12 This expanded definition parallels recent interest in the social and environmental determinants of health, and in linking health care with public health. 5,13 In the U.S., NIH’s National Center for Complementary and Alternative Medicine recently changed its name to the National Center for Complementary and Integrative Health. 14 Thus, although the term “integrative medicine” has a well-established definition, 10 the term “integrative From the 1 University of Maryland School of Medicine, Center for Integrative Medicine, Baltimore, Maryland; 2 Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; 3 The Institute for Integrative Health, Baltimore, Maryland; 4 Osher Center for Integrative Medicine, University of California School of Medicine, San Francisco, California; 5 Center for Social Epide- miology and Population Health, University of Michigan, Ann Arbor, Michigan; 6 Departments of Family Medicine and Community Health, Epidemiology and Biostatistics, and Sociology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio; and Department of Family Medicine and Population Health and Center on Human Needs, Virginia Commonwealth University, Richmond, Virginia Address correspondence to: Claudia M. Witt, MD, MBA, Institute for Complementary and Integrative Medicine, University Hospital Zurich, Sonneggstrasse 6, 8091 Zurich, Switzerland. E-mail: claudia.witt@uzh.ch. http://dx.doi.org/10.1016/j.amepre.2016.11.029 & 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved. Am J Prev Med 2016;](]):]]]–]]] 1