Embracing Wellness

For all the (justified) apprehension about health care reform, the current momentum offers a rare opportunity to reorient the health care system around health and wellness. One of President Obama’s 8 principles for health care legislation is that it must invest in prevention and wellness. Education is needed on how to eat healthy and maintain wellness through disease prevention and early detection, with such efforts supported by physicians, health plans, employers, and the government. Changes are also needed in health plan design and physician education to support a new prevention/wellness paradigm. Possible areas of focus include:

• Eating healthy. In his new book, Younger You, Eric Braverman, MD, founder and medical director of PATH Medical in New York, touts the health benefits of the rainbow diet. The idea is that one’s food choices should include lots of colorful fruits, vegetables, and spices and fewer “white” foods such as pasta, bread, white potatoes, white rice, and salt. He lists the many beneficial compounds found in red, yellow, orange, blue, green, and violet-hued foods. Currently, 25% of the nation’s vegetable consumption is in the form of French fries.

• Curbing obesity. Calorie totals on restaurant menus can guide food choices. Consumers also need to understand the significance of a food’s glycemic index.

• Nutritional supplements. While the use of nutritional supplements needs to be individualized, especially for persons who have chronic conditions and/or are taking medications, the benefits of multivitamins, fish oil, and vitamin D for practically everyone are well established. Supplements should be dosed to promote health and not just to avoid deficiency.

• Health plan coverage. Coverage of cost-effective alternative treatments, such as acupuncture, nutritional counseling, and exercise programs, should be expanded.

• Physicians as wellness coaches. A revamping of medical education and health plan reimbursement formulas is needed to support physician involvement in disease prevention and nutritional support and to encourage behavior change.

• Outreach to vulnerable populations. Although the “Trend of the Month” reveals a strong correlation between health and education level, a study by Brown University researchers (http:// news.brown.edu/pressreleases/2009/05/diet) showed that customized educational programs targeting low-income families can increase vegetable and fruit consumption.

• Employer initiatives. Many employers have launched successful programs accomplishing the twin goals of improving employee health and saving money. Safeway, for example, rewards employees’ healthy behaviors and has improved adherence to treatments for chronic diseases. Through its Healthy Measures program, nearly three-quarters of the supermarket’s 30,000 non-union employees undergo regular screenings for cholesterol, blood pressure, and weight; employees who score well pay lower health insurance premiums.

On May 11, President Obama praised Steven Burd, president and CEO of Safeway, calling him “one of the best practitioners of prevention and wellness programs in the private sector. You have companies like Safeway that have been able to hold their costs flat for their employees at a time when other companies are seeing double-digit inflation in their health care,” Obama added.

How or whether support of such private initiatives and other commonsense measures will be reflected in health care policy proposals is unclear. There is no word yet, for example, on how such employer-sponsored programs would fare if employer-provided health insurance were taxed as is currently being discussed in Congress. Any proposals need to be flexible enough to encourage continued innovation.