Response to the National Prevention and Health Promotion Strategy

As Prepared by the National Prevention, Health Promotion, and Public Health Council

January 13, 2010

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

Incorporated into the mandated strategy of the National Prevention, Health Promotion, and Public Health Council is language calling for recommendations on improving “federal prevention, health promotion, public health, and integrative health care practices…”  Abbreviating the Council name and strategy to read “National Prevention” Strategy and Council dramatically restricts the scope of this work and the ability to positively impact the health status of the Nation.  Utilization of integrative health care practitioners is heavily emphasized in Title V of the Act, which is focused on workforce development. Yet, this Draft Strategy ignores the importance and impact of integrative health care and waylays the concept of health promotion, instead relying on conventional definitions of health care prevention as the underpinning of the strategy.  

While conventional medicine’s focus on treatment of disease has produced many benefits—especially in acute and life-threatening conditions - its effectiveness for the promotion of health and the treatment of chronic disease is limited.  The report is quite comprehensive in its assessment of the range of issues impacting health, including environmental and lifestyle factors.  However, it fails to address the range of health promotion, wellness and true prevention practices utilized by practitioners other than medical and osteopathic doctors.  We know patients are best served when they have access to a team of health care professionals who work together to ensure overall health and wellness.   Patients rely on the many and varied health services provided by naturopathic physicians, advance practice nurses, physical therapists, and many others, all of whom provide quality care and services in states across the country that have a direct impact on health status and the prevention of chronic disease.  

The Advisory Group membership, yet to be named, needs to reflect the breadth of practitioners and institutions who currently serve and educate patients on how to maximize their health status, and prevent chronic disease, including naturopathic physicians.

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

The ability to address those health care conditions, such as diabetes, that disproportionately affect under-served and at-risk populations requires the federal government to utilize the expertise of a larger milieu of health care providers, including naturopathic physicians.  Expansion of eligibility for all Federal Loan Repayment Programs to naturopathic physicians and other providers who are trained to prevent and treat chronic disease is required in any effort to eliminate health disparities. 

Second, redefining our cultural standard of health requires integration of wellness and prevention strategies that address the nutritional, psychological, physical, social, spiritual, and financial needs of the individual person. Stress-related illness accounts for 25-40% of all illness, yet proven strategies for reducing stress including yoga, meditation, and nutritional supplementation are not valued in the current health care system. As a result, we reward practitioners and payors for the most invasive and most expensive treatment strategies.

The naturopathic medical therapeutic order, articulated below, is the basic approach taken by naturopathic physicians to guide patients to wellness, beginning with the least force and moving to more invasive means as necessary. It stands as an example of how the government can redefine our current reliance on diagnostics and integrate effective prevention strategies into a national prevention and health promotion strategy.

  1. Re-establish the basis for health, removing obstacles to cure by establishing a healthy regimen.
  2. Stimulate the body’s inherent ability to maintain and restore optimal health using various modalities and systems of health-botanicals, homeopathy, nutrition, hydrotherapy, touch, counseling, and Chinese medicine.
  3. Support weakened systems using modalities to strengthen the immune system, decrease inflammation, optimize metabolic functioning, balance regulatory systems, enhance regeneration, and increase vitality.
  4. Correct structural integrity, correcting physical imbalances by use of exercise, manipulation, massage, and targeted nutrition.
  5. Prescribe specific natural substances for pathology including vitamins, minerals, herbs, diet, breathing techniques, and hydrotherapies to target specific disease progression.
  6. Prescribe pharmaceutical intervention to halt and palliate disease process.
  7. Recommend surgery, suppressive measures, radiation, and chemotherapy.
And third, the government needs to define “Integrative Health Care Practitioner,” as referenced in the Act.  The AANP proposes the following definition:
An Integrative Health Care Practitioner, acting within the scope of that provider's license or certification under applicable State law, addresses the underlying causal factors associated with chronic disease; improves individual health and increase individual capacity to engage in activities of daily living through lifestyle change, including strategies relating to diet, exercise, smoking cessation, and stress reduction; and provides patient-centered care that

(A) addresses personal health needs;
(B) uses a multidimensional approach to encourage patients to improve their own wellness through lifestyle changes and the use of scientifically based therapies and outcomes based treatments that facilitate the inherent ability of the human body to maintain and restore optimal health, and
(C) utilize clearly defined standards to determine when the implementation of wellness and health promotion activities will be useful for each patient based on the diet, exercise habits, individual health history, and family health history of the patient

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

The Draft Report recommendation to “cross-train professionals in multiple sectors in the delivery of prevention and health promotion strategies” enables all stakeholders to participate in a reinvention of how primary care is delivered.  This cross-training needs to incorporate alternative systems of care, including naturopathic medicine, a system of care rooted in the belief that patient-centered care facilitates the inherent ability of the human body to maintain and restore optimal health.  Utilizing education and training, provided by institutions accredited by Agencies of the U.S. Department of Education, that incorporates nutritional, psychological, physical, social, spiritual and financial needs of the individual person is essential to this initiative.

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

The Draft Report calls for implementation of proven strategies and ongoing research where evidence is either insufficient, where more effective strategies are needed, or where cost-effectiveness studies are lacking.  This affords an opportunity to focus on numerous high-quality, cost-effective medical practice patterns of highly skilled physicians and practitioners, including naturopathic physicians, for the purpose of conducting quality, outcomes-based research.  Funding research for systems of care will enable the development of a new model of primary care; one that incorporates the best of what both conventional and complementary and alternative medicine can offer and focuses on prevention, health promotion, and treatment of the whole person. Utilization of health information technology and electronic medical records in a practice-based research network (PBRN) will enable measurement of effectiveness of health promotion and care to reduce the societal cost and economic burden of chronic diseases, including type 2 diabetes.