"The National Prevention and Health Promotion Strategy (National Prevention Strategy) provides an unprecedented opportunity to shift the nation from a focus on sickness and disease to one based on wellness and prevention."

US Senator Tom Harkin: Does this include the "integrative health care" focus he wrote into the law?

So reads the first line of the DRAFT National Prevention Strategy, subtitled "An Unprecedented Opportunity to Improve the Nation's Health Through Prevention." Sounds good. However, related responses from the integrative practice community indicate that the strategy falls very short of a full embrace of this opportunity.

In November 2010, the Integrator urged members of the community to comment on the framework for the National Prevention Strategy which preceded this December 22, 2010 posting of the draft Strategy. Responses below from the

Recall that the integrative practice community has unusual standing to respond and comment. "Integrative health care" is directly referenced in 3 of the top 4 purposes of the federal entity that is developing the strategy, the

1. What are your suggestions on the Draft Vision, Goals, Strategic Directions, or Recommendations?

2.What evidence-based actions should the federal government take to address the Draft Recommendations?

3. What evidence-based actions should partners (national, state, Tribal, local, and Territorial governments, non-profit, and private) take to address the Draft Recommendations?

4. What measures should be used to monitor progress on implementation of the National Prevention Strategy's Vision, Goals, and Recommendations?

Additional Comments or Suggestions:

The following responses to the "framework" are useful guides for offering input on the draft Strategy. Thanks to the Samueli Institute and ABMP for their leadership in representing the community, and for sharing their responses. Hopefully these will facilitate further participation. Respond as individuals and get your associations moving on this!

Key player in the plan raises serious questions

1.  Samueli Institute

1. The PHPPH Council was deliberately constructed to focus on how Federal policies either facilitate or inhibit health, not solely on the reduction of mortality or through operations of the health care system. As a cross-agency Council, it should first map out metrics for health and flourishing (of which premature death is only one), develop ways to model policy impact on those metrics, and then apply current policies to that model. In this way, the Council can become the guide for how the Federal government can improve national health and lower health care costs.

2. The Council is tasked with processes for continual public input yet one of the best sources would be the Advisory Group which, to our knowledge, has not been appointed (despite the timeline that has passed as established during the July meeting), so I believe that ought to be a priority.

3. Administratively, the title of the Strategy has been shortened to "National Prevention Strategy" which shortchanges the breadth of the Council's title and mandate, so an appropriate title should be used that focuses on health promotion.

4. The Council's purposes include "(4) consider and propose evidence-based models, policies, and innovative approaches for the promotion of transformative models of prevention, integrative health, and public health on individual and community levels across the United States."  It seems the Surgeon General and the Council should implement a more aggressive than is apparent approach to identifying, researching and evaluating approaches--a dedicated effort to identify and provide visibility to approaches effective and not widely implemented.

5. The influence and effectiveness of the Council would be enhanced through access to and recommendations on funding, so a more formal alignment and influence of the Council over the section 4002 Fund would be appropriate (probably through formal recommendations to Congress and HHS leadership).

6. The approach of the draft strategic direction is narrow to prevention of death and seems to be oriented so that "all Federal agencies are included and have a role" more so than covering the wellness spectrum. So a focus on Total Health as a more inclusive approach to wellness would be beneficial. 

7. The Council should highlight the advances made by DoD in view of its challenges of sustaining a healthy force in the face of two prolonged conflicts.

8. The draft goals are two: create community environments that make healthy choice the easy and affordable choice; and implement effective preventive practices.  Seems they are much too narrow and should be enhanced to be more integrative, more wellness and health-promotion oriented, more transformative models, with more recognition of the need to tap the power of positive or negative individual behaviors.

9. The most gain in health and reduction in cost is to focus on the social and environmental determinants of health. More health for the healthy is a marginal investment. Focus on eliminating health disparities would provide greater impact per dollar spent.

10. Specific links to successful community models of health promotion is described in the Council mandate, but the report makes no provisions for creating such links.

11. Insufficient attention is paid to addressing the role of integrative health care, which is an explicit requirement of the Council.

Presenting both massage and the integrative practice perspectives

2.  

• Include CAM practitioners, specifically massage therapists, in the planning and implementation phases of these strategies

• Ensure that integrative health care strategies reflect the true meaning of the word integration, not parallel care (referrals to massage therapists without consultation on treatment planning) or restrictive care (limiting the scope of massage therapy to only address pain conditions, for example)

• Consider the full scope of massage therapy and the contribution massage therapists can make to prevention and wellness strategies, the foundation of most massage therapy practices]

• Consider the need for compliance strategies, an issue that massage therapy can influence. For example, include strategies to enhance self-awareness and self-esteem in an attempt to enhance change motivation and promote healthier choices.

• Take action on factors that impair quality of life such as chronic pain (not only those factors that result in death and disability)

• Consider allocating funds for research on combinations of therapies, adjuncts, or add-ons, not simply comparative either/or studies.

Comment:  This is a model response for any discipline or professional association. Have integrative medical doctors, yoga therapists, holistic doctors, chiropractic physicians, holistic nurses, naturopathic doctors, licensed acupuncturists and similar groups registered their potential contributions?

 

Initial comments note lack or reference to integrative practice

3.  Integrator Comments on the draft framework