The CCE, Wellness, Healthy People 2010 and the APHA-CHC
By Lisa Zaynab Killinger, DC
Wellness: Coming Soon to a College Near You!
As of February 2007, chiropractic education will formally include information and competencies around the theme of "wellness." This change will occur due in part to the implementation of the new Council on Chiropractic Education (CCE) competencies on wellness.Several of the initiators and developers of these competencies (e.g., the CCE Subcommittee on Wellness) are leaders in the oldest and largest health organization in the United States - the American Public Health Association (APHA). This group is well-credentialed to develop these competencies, as it includes chiropractors who have steadfastly held their fingers on the pulse of the larger health care system for more than a decade. Later in this article, you will be invited to step into a leadership role within APHA and join this elite team of chiropractors.
How Well Is Wellness?
The term "wellness" occasionally gets tainted in our profession by those who ascribe the term to a money-making scheme in the field. However, you can rest assured that the CCE does not define wellness as simply adjusting all patients as many times as possible for the rest of their lives or selling them large amounts of mega-supplements. Conversely, the CCE is not going to ignore the importance of the chiropractic adjustment, as it is and always will be the core intervention in the chiropractic doctor-patient interaction; nor will they neglect good nutritional principles. Thankfully, wellness, as per the CCE competencies, should have wide appeal among chiropractic professionals, and is a timely and relevant topic in today's health care market.
The Keys to Wellness
Below, you will find a list of wellness keywords from the CCE Standards. The entire document (if you're interested) can be viewed online: Go to www.cce-usa.org and click on "Standards."1 While looking over these keywords, please remember that chiropractic was all about wellness when wellness wasn't cool! The rest of the health care world finally is coming around to the understanding that health professionals should focus on preventing disease and promoting health, before disease ever occurs.This always has been a core value of public health and of APHA. In fact, the previous three surgeons general of the United States (when speaking at the APHA annual conferences) have made statements (as paraphrased below) that sounded much like what one would hear at a chiropractic philosophy seminar:
"We have to, as health professionals, focus less on crisis intervention and more on health promotion and disease prevention, because it's simply the right thing to do. While we may not see the fruits of this paradigm shift in our lives, we must do this for our children and our children's children."
Wellness is something chiropractors always have not only believed in, but practiced! It's about time the rest of the health care world got that "big idea!"
Keywords in the CCE Standards
Wellness; lifestyle; behavior; physical, intellectual, emotional, and spiritual dimensions; active patient participation; health promotion; communicating effectively; environmental influences; the needs of the patient; screening (all in the context of chiropractic).
Leading Health Indicators
The CCE wellness competencies also call on DCs to become familiar with the nation's leading health indicators,* such as:
*A complete list of the nation's leading health indicators can be found at www.healthypeople.gov.
Wellness and Chiropractic Philosophy: A Good Fit
The overarching goal behind all of this talk of "wellness" is to increase quality and years of healthy life, and to eliminate health disparities. There is literally something for everyone in the wellness competencies, and a great deal that we can agree upon! A quick visit to the APHA Web site will demonstrate the good fit between chiropractic philosophical values, the CCE wellness competencies and the APHA's mission and goals. Check it out at www.apha.org.
Despite the breadth of views in our profession, most chiropractors would love their patients to take a more active role in their own health. That is now an explicit point in the CCE wellness competencies. Most chiropractors also can see the importance of having their patients obtain regular health screenings, to prevent disabling or fatal diseases from being identified too late. We all can agree that preventing needless death among our patients, family and friends is a good thing.
Also, if there is any information gained through chiropractic education or the scientific literature that can improve our patients' quality of life, we have an obligation to share this information with our patients. For example, we have learned that tobacco can aggravate back pain and is responsible for an array of other health problems. We also know that most patients who succeed in quitting do so because "their doctor told them to quit." So, it's simply good practice to ask patients how willing they are to receive information on quitting. We don't necessarily have to counsel the patients ourselves, but we can easily connect our patients with local smoking-cessation professionals and programs.2
Healthy People 2010: What's Up With That?
An important resource that was used in developing the CCE wellness competencies is the Healthy People 2010 document. This resource also can be used to implement wellness into our chiropractic practices. Chiropractic educators and clinicians don't have much time to sort the "wheat from the chaff" in the vast scientific literature pool. Fortunately, Healthy People 2010 has done this for us. This document, available online at: www.healthypeople.gov,3 takes all the leading health topics in the U.S., such as physical activity, nutrition, chronic back conditions, heart disease and others, and gives us a summary of the topic's importance related to health; a summary of the related scientifically sound literature; and suggested goals for helping improve the nation's health through offering good, sound advice, interventions and health screenings.3
Healthy People 2010 is a veritable goldmine for busy chiropractors and chiropractic educators. The topic of this document is now included in the chiropractic national board exams, evidence that it is finding its way into chiropractic classrooms and clinics. Hopefully, it will soon become a mainstay of chiropractic educational programs. The immediate use of Healthy People 2010 is to offer guidance to chiropractic educators on how to accomplish the CCE wellness competencies in their classrooms and clinics.4 Finally, a CCE wellness competencies section that comes with a "how to" book. What more could we want?
Behind the Scenes: APHA-CHC
As mentioned earlier in this article, the profession looks to the Chiropractic Health Care Section of the APHA (APHA-CHC) for leadership related to "beefy" matters such as the CCE wellness competencies and their implementation. This small yet determined group of chiropractic professionals has been leading the charge on wellness, health promotion and disease prevention in the context of chiropractic for decades. This elite group of chiropractors always has focused on serving the health-related needs of the patient. This focus is refreshing given a profession wherein, all too often, seminars and organizations lean toward a focus on personal financial gain as a principle measure of "success."
The APHA-CHC has a powerful voice not only in chiropractic policies and practices, but also in overall U.S. health policy. The APHA-CHC has supported nationwide health initiatives such as combating the overprescription of antibiotics and removing mercury from vaccines - both serious public health issues. This group's strength is directly proportional to its numbers, and a few hundred more chiropractors like you are needed to step up and join this prestigious U.S. health organization. In this way, your voice can be counted on important efforts such as the development of wellness competencies.
A Higher Calling
If you feel you have a higher calling than simply watching the health care system from the sidelines, become a member of the APHA today (www.apha.org). Then take the next important step of communicating with the APHA-CHC leadership, saying, "I want to take an active role in the APHA." Whether it's helping inform chiropractic organizations about larger national health issues and impending health legislation, or informing national organizations about chiropractic's role in health care, you can be a part of something great with APHA-CHC membership. Please feel free to call on me or other leaders within the organization to ask how you can be a part of the bigger picture of health care in the U.S. We look forward to welcoming you to the APHA-CHC.
The CCE, Wellness, Healthy People 2010 and the APHA-CHC
How many of you, before reading this article, truly understood the connections between the four distinct topics listed in the title? Hopefully, this article has brought these terms into focus for you and offered you resources with which to enrich your chiropractic practice or classroom. It is essential that our profession become well-versed in the interrelations between all four topics, and it is wise to utilize important documents such as Healthy People 2010 to inform others how we, as a profession, do "wellness." The APHA-CHC is a venue for learning and educating others on this relationship and on chiropractic's role in health and wellness.
Thank you, CCE, for wrestling the term "wellness" out of the hands of those who use it for personal gain and putting it back where it belongs: in a place where chiropractic education and the needs of our patients will be effectively and responsibly served.