Wellness as a Health ModelBy Carlos López | Mon, 04/12/2021 - 09:14
The COVID-19 pandemic has become the most relevant health problem of the century, but it is worth reflecting on an issue that is just as important as the pandemic.
Given the scourge of the pandemic, vaccination is the most relevant preventive measure. Unlike the healing approach that prevailed in the 20th century regarding health, prevention should be the main focus of the 21st century. While it is true that some forms of prevention gained relevance in the 20th century, and vaccinations are proof of this, there are many other preventive measures that need to be promoted much more intensely in this century, including measures for the development of body and mind wellness.
During the 19th century, the healthcare model focused on addressing diseases. Beyond the limited services provided by the state in this matter, this model included the scheme of a family doctor who built a relationship of trust with patients throughout their lives and to whom they resorted regardless of the illness they suffered. The core of the healing model in this century was getting to know the person treated, and since the therapeutic and scientific knowledge possessed back then was not as broad and effective as it would be in the next century, building a close and long-lasting doctor-patient relationship was essential.
In the 20th century, healthcare evolved and adopted a model focused on attaining much more efficiency of treatment. This was based on having physicians with much more specialized knowledge and on therapeutics and pharmacology that were more effective and better supported by data. The economies of scale, typical of the Industrial Age, and the care of large populations provided by the public and private sectors gained greater relevance when compared to the family/emotional link between doctor and patient.
This was, of course, a great advance and a huge success in the cure and eradication of diseases. However, as in everything, advances and achievements also have a collateral impact. We can say there was a much better understanding of the organs that make up the human body and how to heal them, but the comprehensive knowledge of the person and the attention given to the latter diminished. A patient had to visit different doctors at different times, depending on his/her specific ailments, which took away the close and lasting relationship previously held with a family doctor.
I believe that in the 21st century, we must strive to take a step toward health and to migrate to a model that puts more weight on wellness and prevention than on the curing of diseases without diminishing the importance of the latter. We should focus on preventing diseases instead of curing them and even on developing wellness in the bodies and minds of our populations, allowing them to have a higher quality of life.
According to the WHO, prevention can be classified into three levels: 1) steps taken to prevent the manifestation of disease; 2) early diagnosis and proper treatment of a disease and 3) actions related to a comprehensive recovery following the overcoming of a disease.
For instance, at the first level of prevention, we should devote much more time, resources and efforts to prevent people from becoming overweight, which in turn becomes obesity, in order not to deal later with issues like diabetes and hypertension that would require a cure. Obesity is one of the biggest pandemics of the 21st century that started in the 20th century and it is also one of the main factors indirectly responsible for many deaths among our populations.
In this context, it would be advisable to take greater steps that allow the healthcare professional to implement the advantages of the patient-centric, family/emotional medicine of the 19th century and the technology and therapeutics the 21st century offers in such a way that patients receive a comprehensive treatment that addresses wellness and prevention. This would, consequently, allow care for specific ailments and specialized treatments from appropriate specialists based on the particular conditions of the individual.
This model would start with a visit to a general practitioner who would focus on the well-being of the person (free from disease) by resorting to, among other things, the existing technology and who would treat the simplest ailments. When necessary, the general practitioner would provide advice and refer the patient to the appropriate specialists for the treatment of specific conditions requiring the involvement of other healthcare institutions or professionals. This general practitioner would be responsible for maintaining the health, and, therefore, the well-being of the population.
The capitation models (paying for the responsibility of keeping a population healthy) that have started to develop around the world can be part of this philosophy, paying special attention to ensure people are not submitted to a previous underwriting process based on their health risks.
A health model based on preventive measures also means significant savings in the resources invested in this area while providing better outcomes. For example, since 1998, Lebanon has improved the use of preventive, promotional and health services, especially among poor populations, as well as its health outcomes. The reduced pharmaceutical expenditure, together with other improvements regarding efficiency and prevention, has translated to a reduction in health expenditure as a part of GDP, from 12.4 percent to 8.4 percent.
The model of promoting wellness and quality of life also implies taking prevention and healthcare to where the person is instead of taking the person to locations where healthcare is provided. This is possible for many cases of prevention, diagnosis and even cure due to the existing technology and therapeutics. Wellness and prevention programs should be available where people live, work and within the routes they travel. I wouldn’t have to go to a clinic if I had a doctor and a healthcare area within my company. I wouldn't need to go to a specific place to have my health markers tracked if I had a mobile technology that would allow me to do so from my home, work, and so on.
The promotion of wellness and a good quality of life, and therefore, prevention and health, should be present in every aspect of our daily lives.
If we take this model and add the advances in genetics and their relationship to prevention, we'll have the ideal scenario to migrate from a model centered on treating diseases to one that promotes well-being and good quality of life.