Why do we need Health Coaching?
A Failure of the Disease-Care System.
Today, a critical problem facing the nation’s healthcare system is the prevalence of lifestyle-related chronic diseases. The US Centers for Disease Control and Prevention (CDC) has deemed chronic disease the public health challenge of the 21st century. To that end, the pioneering of a new allied healthcare profession is again underway. The past 10 years have witnessed the birth in rapid expansion of integrative health coaching, which is poised to fill a hole in our current healthcare system and address the need for skilled professionals trained in the science and art of health-related behavior change.
The complex challenges facing our current healthcare system are well documented. Rates of preventable chronic disease have increased significantly in the last three decades and are expected to affect approximately 170 million Americans - more than half the population by 2030. Further the number of Americans with comorbidities is also on the rise; the proportion of US adults with three or more chronic conditions nearly doubled between 1996 (7%) and 2005 (13%). The significant rising chronic disease rates has contributed to rapidly increasing national healthcare costs. The United States currently spends over $2 trillion annually on healthcare. In addition the yearly cost of lost productivity due to chronic illness related absenteeism from work is approximately $1 trillion. Among patients insured privately, through Medicaid, or through Medicare, expenditures for were forecasted to reach $4.6 trillion by 2020.
Three Key Contributors to a Chronic Disease Epidemic
Several key factors contributing to the present epidemic of chronic diseases have been well described.
First, the design of our current healthcare delivery system, including its reimbursement structure, is heavily weighted toward management of disease events over the use of foresight, planning, and disease prevention. Attempts to improve outcomes and reduce costs using innovative disease management programs have proven to be financially unsustainable within a system that rewards hospitalizations and invasive procedures while penalizing outpatient care, risk management, and patient support. Financial incentives should be inclusive of interventions and technologies that achieve desired outcomes in earlier stages before the need arises for costly, invasive treatments often required at advanced stages of disease.
Second, the medical community frequently fails to take full advantage of scientific discoveries, specifically, and ever-expanding body of research that attest to the central role of lifestyle in the development of most chronic diseases. Decades of research have linked a variety of lifestyle factors - such as inactivity, the western diet, smoking, and sustained stress response - with increase risk for major illness and death. Further, the burgeoning field of epigenetics is increasingly able to provide molecular substantiation of the critical roles of environment and behavior toward risk of chronic disease. Lacking an appropriate emphasis on lifestyle modification, the current healthcare model is not aligned with these and other data confirming lifestyle related issues as arguably the major determinant of health.
Last, patients often like a sense of motivation and authority to participate in their own care at the level required for lasting health. This phenomenon is gaining the attention of researchers and clinicians and has been termed low patient engagement and activation. Patient engagement refers to actions individuals must take in order to benefit from the healthcare system. Patient activation has been defined as the cultivation of knowledge, skills, and confidence to manage one's own health. Low patient engagement and activation stand from a wide range of internal and external barriers, including low awareness of risk, limited perspectives on possible improvements, distrust of providers, value conflicts, competing commitments, social pressures, and or environmental obstacles at home or work. Physicians and other clinicians typically lack the necessary time and expertise to explore issues related to behavior change with patients. As a result the need for a mechanism for successful sustained patient engagement and activation - a crucial component of chronic disease prevention - is not met in the current system.
Integrative Health Coaching Fills a Critical Gap.
The field of integrative health coaching and the model developed at Duke Integrative Medicine answer the need for a new healthcare professional skilled at the facilitation of patient engagement and activation. Key functions of integrative health coaching present tenable solutions to the aforementioned three flaws in the current system: 1) cultivation of foresight and proactive health planning, 2) a focus on lifestyle, and 3) a high degree of personalization, clarifying each persons vision values and linked goals while addressing internal and external obstacles to success. As such, integrative health coaching represents a major shift from the current medical paradigm and a venue for much-needed change.
Excerpt from Integrative Health Coach Training: A Model for Shifting the Paradigm Toward Patient-Centricity and Meeting New National Prevention Goals. Smith, L.L. 2013. DOI:10.7453/gahmj.2013.034
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