Integrative Healthcare & Individual Well-being: A Natural Partnership by chpgroup

Research & Evidence

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Integrative Healthcare & Individual Well-being According to the Centers for Disease Control and Prevention (CDC), “Well-being generally includes global judgments of life satisfaction and feelings ranging from depression to joy.”1 The World Health Organization’s (WHO) definition of health is also inclusive of the elements required for well-being, “…a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”2 There is no consensus around a single definition or sole determinant of individual well-being but in general it is dependent on: • Good health • Presence of positive emotions and mood • Absence of negative emotions • Satisfaction with life • Fulfillment and positive functioning • Positive social relationships • Availability and access to basic resources such as housing and income Health enables social, economic and personal development that is fundamental to well-being and health promotion is the process of enabling people to increase control over and to improve their health. This is an active process and individual resources for health can include physical activity, healthful diet, social ties, resiliency, positive emotions, and autonomy. Further, health promotion activities aimed at strengthening personal, environmental, and social resources can ultimately improve well-being. Higher levels of well-being are associated with decreased risk of disease, illness and injury; better immune function; faster recovery; increased

longevity; better work productivity and contribution to community.

Alignment of Integrative Healthcare with Well-being Integrative healthcare (IH) providers have been recognized as holistic – that is, characterized by the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease – in their philosophical orientation to overall health and life. The appeal of IH to individuals includes this holistic philosophy; relationship to health-promoting lifestyle choices, such as regular physical activity; interest in greater knowledge of how nutritional, emotional, and lifestyle factors affect health; and, a broader focus on disease prevention and overall health. Targeting these behavioral and lifestyle choices can provide the largest benefit to health and well-being as these areas account for the majority of premature mortality in the US.3

Integrative Healthcare Utilization According to the 2012 Physician Induction Interview of the National Ambulatory Medical Care Survey (NAMCS PII), a nationally representative survey of office-based physicians, more than half of office-based physicians recommend at least one complementary health approach (massage, manipulation, acupuncture, naturopathic treatment, yoga, herbs/nonvitamin supplements, mind-body therapies, etc.).4 National surveys going back more than 25 years have consistently found that 30-40% of the US population uses complementary approaches for treatment of many conditions.

Integrative Healthcare & Individual Well-being

IH Treatment and Conditions Impacting Well-being Pain | Painful conditions are the most common health condition for which individuals use integrative healthcare (complementary) approaches. Based on national survey data, complementary health approaches for management of back pain accounted for $8.5 billion in out-of-pocket payments.5 Historically, people with chronic pain are frequent users of complementary and alternative services.6 Chronic pain continues beyond the normal time expected for healing and is associated with the onset of changes in the central nervous system that may adversely affect an individualâ&#x20AC;&#x2122;s emotional and physical well-being, cognition, level of function, and quality of life. There is a wide range of these therapies and treatments and there are many reasons individuals use them, not the least of which is failure of current treatment to relieve their pain. The appeal also includes the opportunity for greater personal involvement in health maintenance, holistic health beliefs, and for those with chronic conditions, an active coping mechanism.7 The effects of IH on patients with chronic pain were highlighted in a 2019 journal article in Spine where chiropractic care was included for 2024 patients with chronic lower back or neck pain,

The results of this study contribute to the literature by providing evidence that chiropractic care is associated with improvements in functioning and well-being among individuals with chronic low back or neck pain.8 Absenteeism | Health-related absenteeism costs an estimated $153 billion annually in the US. Chronic conditions are often successfully managed by integrative healthcare (also called complementary and alternative medicine (CAM) in some research). Estimates suggest that these modalities correlate with lower absenteeism, and may correlate with improved health. In this study sample of 8,820 workers, visiting an acupuncturist correlates with lower absenteeism in men and visiting a naturopathic doctor correlates with fewer workdays missed for women and men. Active mind-body practices, massage, chiropractic and acupuncture treatments are all significantly associated with improved health.9 Anxiety, Depression, Pain Interference, Sleep Disturbance | In a smaller study, acupuncture demonstrated positive effects over time on contributors to well-being including anxiety, depression, pain interference, and sleep disturbance using National Institute of Healthâ&#x20AC;&#x2122;s Patient Reported Outcomes Measurement Information System (PROMIS) Quality of Life (QOL) assessment tool.10 Pain and Quality of Life | A study by Secor et al. at an integrative pain clinic found significant improvement in pain scores and quality of life measures. This included groups who received naturopathic care, chiropractic care, and acupuncture. This meta-analysis indicated that receiving whole-system naturopathic medicine is associated with improved health outcomes,

as well as improved quality of life in patients with or at risk for chronic conditions including cardiovascular disease, diabetes, chronic pain, anxiety, multiple sclerosis, hepatitis C, as well as menopausal symptoms. Although cost effectiveness data are limited on naturopathic medicine in the context of chronic disease, the data thus far suggests the use of naturopathic medicine results in cost savings to employers as well as reductions in societal costs.11

Evidence for Use of Integrative Healthcare The National Center for Complementary and Integrative Health (NCCIH) is the United States government agency that explores complementary and integrative healthcare. It has documented in greater detail some of the evidence supporting health conditions and treatment approaches IH providers use to improve health and well-being of patients.12 Acupuncture | Chronic neck and back pain, knee osteoarthritis, headaches, certain symptoms associated with cancer treatment (nausea and vomiting), seasonal allergies, fibromyalgia, depression Massage | Cancer-related pain and anxiety, fibromyalgia, acute and subacute low back pain, neck and shoulder pain Spinal manipulation | Back and neck pain Yoga, Tai Chi, Qi Gong, meditation, mindfulness-based stress reduction | Depression, stress, anxiety Exercise | Stress, anxiety

The former NCCIH director Dr. Josephine Briggs commented in 2015, â&#x20AC;&#x153;â&#x20AC;ŚI find it especially interesting that people who use a variety of complementary health approaches report better health and well-being.â&#x20AC;?13

Why Include Integrative Healthcare in Your Employee Benefits The positive impact integrative healthcare contributes to well-being is a product of the holistic approach these providers have during their interactions with health-seeking individuals. The inclusion of these health-promoting lifestyle choices is essential to enable individuals to increase control over and to improve their health and ultimately their well-being.

Endnotes 1 Centers for Disease Control and Prevention. Health-related Quality of Life (HRQOL)-Well-being concepts. https://www. cdc.gov/hrqol/wellbeing.htm. Accessed March 14, 2020. 2 Office of Disease Prevention and Health Promotion. Health-related Quality of Life & Well-being. https://www.healthypeople.gov/2020/topics-objectives/topic/health-related-quality-of-life-well-being. Accessed March 14, 2020. 3 Ali A, Katz DL. Disease prevention and health promotion how integrative medicine fits. Am J Prev Med 2015;49(5S3):S230-S240 4 Stussman BJ, Nahin RR, Barnes PM, Ward BW. US physician recommendations to their patients about the use of complementary health approaches. J Altern Complement Med 2019;00(00):1-9 DOI: 10.1089/acm.2019.0303 5 Nahin RL, Boineau R, Khalsa PS, et al. Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clin Proc 2016;91(9):1292-1306 6 Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. Available from: https://www.ncbi.nlm/nih.gov/books/NBK91497/ doi:10.17226/13172 7 2010 Pain Management Task Force: Office of the Army Surgeon General 8 Hays RD, Spritzer KL, Sherbourne CD, et al. Group and individual-level change on health-related quality of life in chiropractic patients with chronic low back or neck pain. Spine 2019;44(9):647-651 9 Rybczynski K. Alternative medicine, worker health, and absenteeism in the United States. Complement Ther Med 2017 Jun;32:116-118. 10 Victorson D, Beaumont JL, Mahadevan R, et al. Acupuncture-related quality of life changes using PROMIS computer adaptive tests in a pragmatic trial with oncology and general integrative medicine patients: the role of baseline acupuncture expectations. J Altern Complement Med 2016;22(10):778-787 11 Oberg EB, Bradley R, Cooley K, et al. Estimated effects of whole-system naturopathic medicine in select chronic disease conditions: a systematic review. Altern Integr Med 2015, 4:192 12 National Center for Complementary and Integrative Health. Health topics A-Z. https://nccih.nih.gov/health/atoz.htm. Accessed March 14, 2020. 13 National Center for Complementary and Integrative Health. Wellness versus treatment: the reason why people choose complementary health approaches. https://nccih.nih.gov/about/offices/od/wellness-vs-treatment. Accessed March 16, 2020.

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