In our first blog post of this series, we discussed how the current medical approach misses so much of what influences health, and how it perpetuates health inequities in our society. In this post, we go in-depth on the elements of Whole Person Health (WPH) that are necessary components of a just and equitable approach to health and healing.
Whole person health is a relationship-based approach that starts the conversation with patients on “what matters?” rather than “what is the matter?” The interaction begins with what is most important to a person’s life and then centers self-care and treatment recommendations based on this vision.
WPH leverages evidence-based medical recommendations, lifestyle approaches and non-pharmacologic treatments (also known as complementary and alternative medicine). Instead of solitary physicians, teams of health professionals support individuals in addressing all the factors that influence their health and healing: social, environmental, lifestyle, behavioral, emotional, spiritual and physical.
Funding social care initiatives is an essential component of a health equity strategy. Yet, attaching community SDOH strategies to existing health care approaches will not alleviate the inadequacy of and damage caused by current medical constructs. Here are seven ways that WPH helps us attain health equity:
1. It emphasizes person-centered care
Medical visits often have a power imbalance. Doctors are “the experts” and patients are expected to follow their advice regardless of personal preferences or circumstances. Our language reflects this as well. We refer to patients as “non-compliant” or “refusing treatment”. Health providers may think (or say), “Of course, they are still sick if they won’t take their medicines.” And they may question, “Why come see me if patients won’t do what I recommend?”
Further, medicine still often labels people by their symptoms or illnesses. People with a substance abuse problem are called “drug-users”. Individuals with diabetes are called “diabetic”. And people with a mental health issues are “mentally ill”. We do not see the patient as a whole person who experiences health issues. Such stigmatizing language can spread bias against a patient and affect their subsequent care. Stigmatizing language is, not surprisingly, more likely to occur in the medical charts of Black persons and those with Medicaid insurance.
WPH, however, aims to change the power dynamic. Shifting from a doctor-patient interaction to a relationship built on respect and trust is the first step to justice. WPH acknowledges the person before the health problem. Each individual’s values and preferences then guide treatment plans. And this creates an empowering system, reinforcing a person’s resilience and ability to heal.
2. It addresses more dimensions of health and healing
WPH takes into account all of the elements that influence health and healing, including social, environmental, lifestyle, behavioral, emotional, spiritual, and physical. The goal is to understand individuals at a deeper, holistic level that is in line with their values and beliefs. We can then help optimize many of the elements that create the person’s own version of health and wellbeing.
WPH supports lifestyle and behavior change. Health coaching and group visits are key to changing the way we approach lifestyle and behavior change. Instead of telling people what to do, the focus becomes sharing information in a way that helps people make their own health decisions. Coaches and group visits help people make changes at their own pace and with patients’ own goals, priorities, and realities in mind. Additionally, group visits have the advantage of providing the healing qualities of social connections and building community.
WPH’s strong emphasis on addressing the social determinants of health (SDoH) aims to help reduce health disparities. Health professionals work to address the underlying causes of disease rather than placing all the burden on individuals to change. WPH recognizes society’s role in creating poor health for many people. Moving from blame to collaboration lets the patients partner with their health team. Now they can set their personal goals and make their own treatment plans. With the help of a team, it is easier to tackle social factors that can make it hard to be healthy. Some of this work can occur outside of the medical setting by establishing relationships with community programs. If a community has a managed social care referral network, for example, clinics can use it to connect individuals to social services.
3. It supports non-drug approaches
Most providers ignore approaches to improving health that not taught in medical school. But there is ample evidence for other modalities. Mind-body practices have been shown to improve health and help mediate the downstream effects of stress and trauma. This includes mindfulness-based stress reduction, tai chi, and yoga. Other techniques, such as herbs or bodywork, might also be beneficial for some people. These non-drug approaches are often available only to those who can afford to pay out of pocket. Most insurances don’t cover these services. When some treatments are only available outside of the current payer system, health disparities may be worsened.
WPH uses non-drug approaches alongside conventional medical treatments, allowing patients to choose what works for them in their lives. For example, WPH providers may teach yoga and meditation to patients. In other cases, they may connect patients with team members or community practitioners that can provide these services. Non-conventional interventions such as qi gong or acupuncture can also be delivered in group settings, further improving access. This can level the playing field when working towards health.
4. It emphasizes team-based care
WPH uses teams for many reasons. It can be hard for individual practitioners to adequately support people on their health journey. Collaborating with professionals like physical therapists, dietitians, and community health workers can bring different perspectives and improve patient care. And teams of health advocates and healers may be collectively more familiar with the neighborhood and local resources. Teams may also help alleviate burnout and moral injury that is problematic in health care today.
Additionally, teams may bring increased racial/ethnic diversity to patient care. Some patients prefer providers of the same race/ethnicity. And addressing such preferences may benefit patient care. For example, one study showed that Black patients are more likely to receive preventive screening when cared for by Black physicians. Until the medical educational system changes, the doctors on the team are not likely to be very diverse. Allied health professionals, however, are more likely to be racially or ethnically representative of the communities they serve.
5. It values family, community and cultural context
Individuals belong to families, and families exist within communities. WPH brings families and communities into the conversation. Knowing the issues that affect a community gives health care teams a wider view of a person’s health. When culturally appropriate, we can use this lens to see how these factors influence chronic conditions and illnesses. Teams use cultural humility as a way to better understand patients and ensure treatment recommendations are consistent with their beliefs and preferences. Teams consider and address outside influences and screen for unmet social needs. Then, the person can be connected to the appropriate services.
6. It reduces implicit bias
Many health care professionals feel rushed and overwhelmed. Experiences of burnout and the resulting depersonalization may contribute to bias in medical care. A team-based approach can reduce the workload for a single practitioner, allowing them to slow down and spend more time with patients. And this slowing down may reduce implicit bias as a result. WPH encourages health professionals to do just that, slow down and get to know patients as individuals.
WPH also addresses bias in care through:
- “Partnership building,” with the emphasis on ongoing relationships
- “Individuation,” the person-centered approach
- “Perspective-taking,” positioning as partners for health, rather than experts
7. It emphasizes cultural humility and trauma-responsive care
Medical encounters can be distressing for BIPOC, LGBTQ+ and others who the health care system has mistreated. In addition, many people have had terrible traumas in their lives, and experiences with the medical system can compound their pain. WPH aims to reduce the trauma the medical system itself can cause. Health teams practice cultural humility and trauma-responsive care. These replace judgmental attitudes and allow us to work side-by-side with people in support of their healing.
Achieving health justice
Health is an issue of social justice. How do we care for the least resourced, the most vulnerable, the “othered”? Outdated or racist social structures have already caused harm and created obstacles that are perpetuated in the current health system. It is the duty of those with power to ensure that people are healthy and thriving. Individuals’ values, priorities, and context should be central to their health care.
The Whole Person Health approach lets health professionals see each person fully. A patient’s wellbeing should be seen by health care providers as a reflection of their life and environment. Only then can providers partner with people to support their health and resilience. WPH provides many roads to wellbeing and partners with the patient to choose their individual path. It can be the foundation of a new and more just health care system and offer a pathway to health justice.
Elena Rosenbaum
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Marva Richards
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Andrea Gordon