Integrative Health Care: The New Military Strategy

Without saying the "p" word -- psychology -- the Veterans Health Administration has turned to integrative health approaches to address health challenges that run the gamut from post-traumatic stress disorder and physical disabilities to divorce, brain injury and suicide.
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"Right now, veterans and their families are bearing the burden of the health impacts of a decade of war," Lt Col. Windy Hendrick, Air Force fighter pilot told the group gathered for the day-long seminar on Integrative Medicine in Action hosted by the Bravewell Collaborative. Working with the Wing Fitness program for the Arizona National Guard, Hendrick, a certified health coach, exemplifies the new face of integrative medicine in military settings. She blends physical fitness, mindfulness and coaching to support veterans addressing an array of health challenges.

In the military, up until recently, it's been an unspoken taboo to avoid treatment, because "60 percent of the military believe that seeking psychological help will harm their career," said Hendrick. But now, without saying the "p" word -- psychology -- the Veterans Health Administration (VHA) has turned to integrative health approaches to address physical and psychological health challenges that run the gamut from post-traumatic stress disorder and physical disabilities to divorce, brain injury and suicide.

"That," Hendrick noted, "is in addition to the obesity that also afflicts the U.S. population as a whole."

Due to major and chronic health challenges among vets, the VHA, which in 2010 treated six million veterans, now "partners with families," through offering quote-unquote "tactics" for veterans' quote-unquote "wellbeing plans." The miliary's re-languaging of integrative medicine signals a shift in military culture.

"It's a shotgun wedding between people who wouldn't choose to eat together in the lunchroom," concedes Col. Kevin Galloway, chairman of the army's Pain Management Task Force. "You can't order a cultural change. But we are the military."

There are strong financial imperatives for this change of approach, according to Kenneth H. Paulus, President and CEO of Minneapolis-based Allina Health System. "Health care, the we way we do it is just too costly," he said. Especially since, with an annual tab of $2.5 trillion dollars, the "average U.S. life expectancy ranks 27th in the world."

According to Dr. Tracy W. Gaudet, M.D., the VHA health care system outperforms the private sector health through producing better outcomes. Since the VHA also has a long history in leading innovation, their adoption of integrative medicine could help dissolve the highly defended boundary between integrative and conventional care.

The lifestyle changes many people have learned from the integrative approach have been adopted on an individual basis rather than encouraged systemically. The dilemma has always been, "How do you scale it up?" reflected Dr. Jonathan LaPook, M.D., the CBS Evening News Medical Correspondent, who moderated the seminar. "How do you build a system so that integrative medicine is not just for the well-heeled?"

Addressing this challenge has been a major goal of the 10-year-old Bravewell Collaborative, which hosted the seminar and an award dinner later that evening. Bravewell promotes integrative medicine by building the infrastructures that support its use and adoption within the conventional health care system to improve health outcomes and to lower costs.

"The kind of changes we need are big changes," said Dr. Mehmet Oz, M.D., a keynote speaker. "For years, people said that there was no evidence behind this form of medicine. Now there is."

"We can't afford the health care system we've built," said Paulus. "We've broken the bank. We've run out of money. People don't change until they have to. Now we have to. That's where we are today."

"What I learned in medical school has a place -- and that place is in acute care," said Dr. Erminia "Mimi" Guarneri, M.D., the 2011 recipient of the Bravewell Leadership Award. "In the 1980s, we believed that statins would prevent cardiovascular disease [CVD]. We spend $13.6 billion annually on statin therapy alone. But statins don't cure CVD. Lifestyle changes do."

"We incentivize for disease care treatment and we don't incentivize to make societal policies that keep people well," said Dr. Gaudet, who moved from her position as executive director of Duke University Integrative to serve as the director of the new Veteran Health Administration Office of Patient-Centered Care and Cultural Transformation. Dr. Gaudet is hopeful that, "If we can get this right and demonstrate what can be done in smaller sites, we can model how it can be done nationally."

It would be ironic if the upside to the unpopular and costly Iraq War were to be a new military model for integrative medicine. The need for a sociocultural shift to create better health is not confined to the military, an issue I cover in my upcoming book as well as in several prior HuffPost blog posts written during the dialogue for health care reform, which can be seen here and here.

Despite the nearly three decades of integrative wisdom on diet and other healthy lifestyle changes, Dr. LaPook noted that, "There's a trillion-dollar business that makes us eat what isn't healthy. People don't have the will power to avoid poor quality food that surrounds them. How do you make it so that unhealthy behavior is not on the menu?"

Allina's chief clinical officer, Dr. Penny Wheeler, M.D., shared the results of Allina's pilot program in creating a health-promoting social environment in Ulm, Minnesota. "It was the land of beer, butter and bratwurst, but we worked with this community to find innovative ways to help eliminate heart attacks. We did screening for risk assessments, social media and workplace wellness. We even had people in the supermarket look into peoples' grocery carts," Wheeler recounted.

The results?

"The heart attack rates in Ulm are 24 percent lower than prior year. It's trending in the right direction." Wheeler pointed out. "If you engage a community, that helps to redefine normal."

"Outside influence can support our health and wellbeing. Or not," said Christy Mack, the chairman and director of the Bravewell Collaborative. "If we want our communities to be healthy, we must make sure that all the decisions we make, make health the top priority."

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

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