Expanding the Horizons of Health

"Our modern sophistication with biomedical technology is matched on the negative side by an often shocking lack of sophistication or interest in helping patients become aware of and participate in their own healing process," writes Michael Lerner in Choices in Healing. The difference between "curing" and "healing" is profound. "A cure is a medical procedure that reliably helps you recover from an illness. Healing is an inner process through which the human organism seeks its own recovery--physically, mentally, emotionally, and spiritually."

By focusing on the disease rather than the patient, the health care system has failed to promote good health and the inner process of healing. Health has less to do with the absence or presence of disease than it has to do with outlook on life and ability to function. A person's assessment of her ability to control her life, her sense of herself as a contributing member of a social network, and her vision of her future are the true indicators of a healthy individual and, perhaps, the key to health-related behavior and life choices. Yet, many health care providers appear to believe that if they can't cure the disease, they have nothing left to offer.

Expanding the concept of health care to include a focus on health and well-being, as well as a focus on disease, is critical. As the population ages, chronic disease is affecting an increasing number of people. While medicine cannot provide a cure for those with chronic illness, it can develop and endorse treatments which demonstrate caring, provide comfort, and teach skills patients can use to improve function. In addition, modern lifestyles are such that increased attention to prevention by the medical profession is essential.

Research Verifies the Mind/Body Connection

Over the past several years, a growing body of research has demonstrated not only that mental and emotional states affect physical health, but that effective psychological and behavioral methods can assist healing, supplementing the practice of conventional medicine. For example, David Spiegel, M.D., of the Stanford School of Medicine, found that there was an improvement in the quality of life of women with advanced metastatic breast cancer who took part in psychotherapeutic support groups. In addition, he found that the women survived twice as long as other breast cancer patients with similar medical care but no support group.

Dean Ornish. M.D., of the University of California, San Francsico, showed that a regimen of yoga, meditation, group support, exercise, and diet can reverse the course of heart disease. According to Ornish, all the people in his study shared a sense of isolation and alienation, a state of mind that Ornish and a number of other researchers assert can cause chronic stress and disease. "Anything that helps us reconnect with parts of ourselves that we've walled off, increase intimacy, and transcend our spiritual isolation," Ornish said, "is healing in the basic sense of the word, to make whole."

Most of the data available on the efficacy of mind/body interventions focus on white, middle class subjects. Similarly, the populations served by well-known programs addressing the impact of emotional states on disease progression (e.g., the Wellness Community) often reflect that same demographic profile. Much of the data on the health needs of low-income people address socioeconomic barriers to health such as food, shelter, access to health care, and the like. Removing those barriers is essential to the survival of poor and low-income people. Hence, organizations such as the Center for Budget and Policy Priorities, the Food Research and Action Center, and the National Association of State-Based Child Advocacy Organizations--i.e., organizations that work to assure that low-income families gain access to the government-supported programs designed to meet basic human needs--play a critical health-related role.

Just as it is important for poor and low-income people to have access to goods and services which meet their basic human needs, it is important that they develop the life skills necessary to identify and ameliorate the stressors in their lives. The stress we all suffer increases a thousandfold for the poor and for low-income people who are forced to live from check to check. Everything that goes wrong in the lives of those without much disposable income can lead to a major crisis. The discrimination faced by people of color increases stress as well.

Mind/body approaches improve the health and health outcomes of these constituencies. Jon Kabat-Zinn, Ph.D., of the University of Massachusetts Medical Center in Worchester, conducted a study to determine if the stress reduction techniques that had improved the health outcomes of predominantly middle class patients would help racially and culturally diverse low-income patients. The results of the study indicate that mindful stress reduction techniques also enhance healing for low-income people and people of color.

Youth Services Promote Health Through Self-Worth

Isolation and alienation are not the sole property of adults. Approximately 50 percent of young people are at moderate to high risk of suffering serious mental or physical health problems associated with poverty, various kinds of substance abuse, delinquency, and unprotected sex. Yet, little is known about how to best deliver and market preventive health services for adolescents. the National Network of Runaway and Youth Services approached this problem by asking young people for advice on how to design the programs aimed at serving them.

By conventional standards, the member organizations of the National Network of Runaway and Youth Services do not even provide health services. However, if their work is assessed against an expanded view of health, it is clear that creative youth workers who involve young people in program design are also addressing the health needs of adolescents. The best programs enable youth "to develop their own identity, self-worth, independence, and sense of belonging, as well as connections to family, community, the earth, and the sacred." Feelings of self-worth and belonging are good for your health.

The programs created by Spiegel, Ornish, Kabat-Zinn, and the National Network of Runaways and Youth Services encourage people to see themselves as actors who can make a difference in their own lives. These programs acknowledge the existence of external stressors which have a negative impact on health and health outcomes, but they focus on what people can do to ameliorate the effect of those stressors on their lives. They walk the fine line between encouraging self-care (e.g., regulating diet and exercise, seeking emotional support from others, learning and practicing methods for maintaining emotional balance) and suggesting that illness is a personal failure. And, they share a theoretical framework which asserts that the individual should be at the center of health-related decision-making.

The Foundation Will Focus on Birth and Death

Nowhere is patient-centered care more important than at the beginning and end of life. Over the next few years, the Nathan Cummings Foundation will focus its grantmaking in health on improving the quality of life for these people: pregnant women and children below the age of six, and people who are facing death. There are at least three reasons for focusing health resources on these stages of everyone's life.

1. The way in which a society deals with its members at the beginning and end of life reflects its values.
2. People are often more open to transforming their lifestyles when they are addressing issues of birth and death than they are at any other point in their lives.
3. Birth and death are natural parts of life that appear to have been made overly burdensome to patients, families, and communities by the health care system's tendency towards isolating patients and by the sometimes unnecessary intrusion of medical technology.

   As in the past, the Foundation will pay particular attention to projects that recognize the link between emotional states and physical health and demonstrate a sensitivity to the multiracial and multicultural nature of this society.