Health Care for the Whole Person Statement of Vision and Principles

We, the undersigned health, public health, consumer, and health care groups consider the following to be important characteristics of health, public health, and health care as each currently exists in the United States:

The dominant conceptual model of health in the United States, and as a result, the U.S. health care system, artificially separates the mind and the body. This separation has a negative impact on health care access, health care costs, and quality of care with a disproportionate share of the burden falling on women, racial and ethnic minorities, and immigrant populations. Furthermore, this separation has a negative impact on public health as opportunities for prevention, education, and early intervention are denied.

The structure of the U.S. health care system diverges from the types of symptoms and problems patients and their families bring to their providers. Stigma and reimbursement issues are frequent barriers to appropriate health care.

A strong, integrated health care system and approach to public health in both urban and rural areas are the central (and missing) pieces of the health care puzzle.

There is abundant scientific evidence that behavioral, psychological, spiritual, and psychosocial factors are significant determinants of health status, healing, and health care utilization for all ages, including older adults.

Healthy People 2010 selected “Leading Health Indicators” “on the basis of their ability to motivate action, the availability of data to measure progress, and their importance as public health issues” across the life span. These indicators are:

“Physical Activity Overweight and Obesity Tobacco Use Substance Abuse Responsible Sexual Behavior Mental Health Injury and Violence Environmental Quality Immunization Access to Health Care” (USDHHS, 2000).

The ten most common problems adult patients bring to primary care--chest pain, fatigue, dizziness, headaches, swelling, back pain, shortness of breath, insomnia, abdominal pain, and numbness--together account for 40% of all primary care visits, but only 26% of these have a confirmed biological cause;

Childhood psychosocial dysfunction, viewed 25 years ago as a “new morbidity,” is now recognized as the most common, chronic condition of children and adolescents... 50% of these children are identified by their primary care physicians.

Primary health care providers treat 75% of all mental health problems of which depression, anxiety, trauma sequelae, and family stress are the most prevalent.

Seventy percent of patients coming to primary care bring one or more family members, thus presenting an opportunity for family-focused care and for providers to work in partnership with patients;

U.S. expenditures on health care are now 14.9% of the Gross Domestic Product (GDP). Total health care expenditures per capita have almost doubled since 1990 to $5,440 in 2002; overall health care costs increased at a rate of 7.3 % in 2003; and Health Maintenance Organization (HMO) rate increases were 17% in 2004.

We note that many of the nation’s leading health and health care entities have strongly endorsed new, integrated approaches to health and health care:

Institute of Medicine
“Ensuring cooperation among clinicians is a priority” (Committee on Quality of Health Care in America, 2001)

“A fundamental shift in the national perspective of the value and importance of psychological health...” (p. 117, Goldfrank et al., 2003)

National Institutes of Health
“...behavioral scientists, molecular biologists and mathematicians might combine their research tools, approaches and technologies to more powerfully solve the puzzles of complex health problems such as pain and obesity...with roadblocks to potential collaboration removed, a true meeting of the minds can take place...” (National Institutes of Health, 2004)

President’s New Freedom Commission on Mental Health
“The integration of mental health and physical health is a crucial next step...”

“bridge the differences between the mental and physical health communities...” (Mental Health Commission, 2003)

The Future of Family Medicine
“recognizing fundamental flaws in the fragmented US health care systems and the potential of an integrative, generalist approach...the project identified...a New Model of practice [with the] following characteristics: a patient-centered team approach...patient care in the new Model will be...multidisciplinary team approach...will include behavioral scientists...” (Kahn, 2004)

U.S. Surgeon General
“mental health care should flow in the mainstream of health care …[to] mend the destructive split between mind and body....” (USDHHS, 1999)

“A balanced community health system balances health promotion, disease prevention, early detection… require(s) a partnership between primary care and mental health.” (USDHHS, 2001)

Therefore, the undersigned health and health care groups endorse the promise of an integrated primary health care system and multidimensional approach to public health that

Rests on a biopsychosocial model of health and health care;

Meets the definition of quality of care;

Reduces the burden of illness and injury by an evidence-based emphasis on healthy behavior and psychological health in addition to physical health;

Reduces the incidence of untreated mental health problems;

Contributes to more effective use of resources and helps reduce the cost of health care with targeted, focused psychological health services in addition to physical health services;

Improves provider-patient relationships and satisfaction with care, and encourages patient-centered care;

Promotes healthy lifestyles and disease prevention.

In addition, integrated health care and biopsychosocial public health will help address the adverse health and mental health impact of environmental and psychosocial factors such as prejudice, discrimination, poverty, racism, disability, heterosexism and homophobia, and minority group stress.

We, the undersigned health, public health, and health care groups, believing a healthier population and a more rational health care system will result, affirm our intention to work together toward the development and application of a fully integrated health care and public health system.

Partners of the Health Care for the Whole Person Collaborative

1. American Association of Pastoral Counselors
2. American College of Nurse Practitioners
3. The American College of Obstetricians and Gynecologists
4. American Nurses Association
5. American Orthopsychiatric Association
6. American Public Health Association
7. American Psychological Association
8. American Psychosocial Oncology Society
9. American Society for Reproductive Medicine
10. Association of Academic Health Centers
11. Association of Asian Pacific Community Health Organizations
12. Bazelon Center for Mental Health Law
13. The Carter Center Mental Health Program
14. Center for the Advancement of Health
15. Collaborative Family Health Care Coalition
16. Consumers Union
17. Families USA
18. National Association of Community Health Centers
19. National Association of County and City Health Officials
20. National Association of School Psychologists
21. National Association of Social Workers
22. National Coalition of Mental Health Professionals and Consumers
23. National Latino Behavioral Health Association
24. The Society for Adolescent Medicine
25. Society for Behavioral Medicine
26. The Society of Teachers of Family Medicine

Definitions

Integrated care is health care that addresses physical, mental, and behavioral health issues at the same time and is optimally provided by a multidisciplinary team of providers.

According to its author, George Engel, MD, the bioposychosocial model adds “the patient, the social context in which he lives, and the complementary system devised by society to deal with the disruptive effects of illness” to traditional medical issues (Engel, 1977; p.135).

References

Brown, R. T., Freeman, W. S., Brown, R. A., Belar, C., Hersch, L., Hoynyak, L. M., et al. (2002). The role of psychology in health care delivery. Professional Psychology: Research and Practice, 6, 536–545.

Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health care system for the 21st century. Washington, DC: National Academies Press.

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129–136.

Goldfrank, L. R., Wong, M., Ursano, R. J., North, C. S., Quinlisk, P., Wallace, N., & Jacobs, G. A. (2003). Preparing for the psychological consequences of terrorism: A public health strategy. Washington, DC: National Academies Press.

Kahn, N. B. (2004). The future of family medicine: A collaborative project of the family medicine community. Annals of Family Medicine, 2(Suppl. 2), S3–S32.

McDaniel, S., Hepworth, J., & Doherty, W. (1992). Medical family therapy. New York: Basic Books.

Mental Health Commission. (2003). President’s New Freedom Commission on Mental Health. Retrieved from www.mentalhealthcommission.gov

National Institutes of Health. (2004). NIH roadmap: Interdisciplinary research overview. Washington, DC: Author.

Rathore, S. S., Berger, A. K., Weinfurt, K. P., Feinleib, M., Oetgen, W. J., Gersh, B. J., & Schulman, K. A. (2000). Race, sex, poverty, and the medical treatment of acute myocardial infarction in the elderly. Circulation, 102, 642–648.

Stancin, T. (1999). Special issue on pediatric mental health services in primary care settings [Introduction]. Journal of Pediatric Psychology, 24, 367–368.

Travis, C. B. (2005). Heart disease and gender inequity. Psychology of Women Quarterly, 29, 15–23.

U.S. Department of Health and Human Services. (2001). U.S. Surgeon General’s working meeting: Integration of mental health services and primary health care [Report]. Rockville, MD: Office of the Surgeon General.

U.S. Department of Health and Human Services. (2000). Healthy People 2010 [Report]. Rockville, MD: Office of the Surgeon General.

U.S. Department of Health and Human Services. (1999). Mental health: A report of the Surgeon General. Retrieved from http://www.surgeongeneral.gov/library/mentalhealth/home.html