WELLCOME

926.03 Advanced Interventions

Wellness & Prevention

Dr. Paul F. Granello, PhD LPCC

Status of Healthcare in U.S.

• Spending 2.16 trillion a year

– Less then 1% on prevention of disease

• 2002 our healthcare spending was 15.2% of our total GDP

• Medical premiums rose an average of 14% in 2002 (Hays 2002)

• Prescription drug expenditures increased 17% in from 1990 to 2000 and continue to rise

3 Leading Causes of Death United States 1900

1. Pneumonia

2. Tuberculosis

3. Enteritis, Colitis

Americans Died of Infectious Diseases

Leading Causes of Death United States 2004

•   Heart disease: 654,092•   Cancer: 550,270•   Stroke (cerebrovascular diseases): 150,147•   Chronic lower respiratory diseases: 123,884•   Accidents (unintentional injuries): 108,694•   Diabetes: 72,815•   Alzheimer's disease: 65,829•   Influenza/Pneumonia: 61,472•   Nephritis: 42,762•   Septicemia: 33,464

Prevalence of Obesity* among U.S. AdultsBRFSS, 1991

(*Approximately 30 pounds overweight)

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

<10% 10% to 15% >15%

Prevalence of Obesity* among U.S. Adults

BRFSS, 1992

<10% 10% to 15% >15%

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

Prevalence of Obesity* among U.S. Adults

BRFSS, 1993

<10% 10% to 15% >15%

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

Prevalence of Obesity* among U.S. Adults

BRFSS, 1994

<10% 10% to 15% >15%

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

Prevalence of Obesity* among U.S. Adults

BRFSS, 1995

<10% 10% to 15% >15%

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

Prevalence of Obesity* among U.S. Adults

BRFSS, 1996

<10% 10% to 15% >15%

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

Prevalence of Obesity* among U.S. Adults

BRFSS, 1997

<10% 10% to 15% >15%

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

Prevalence of Obesity* among U.S. Adults

BRFSS, 1998

<10% 10% to 15% >15%

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

Physical ActivityPhysical Activity

Diabetes Trends* Among Adults in the U.S.,

(Includes Gestational Diabetes) BRFSS 1991-92

Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

Diabetes Trends* Among Adults in the U.S.,

(Includes Gestational Diabetes)

BRFSS 1993-94

Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

Diabetes Trends* Among Adults in the U.S.,

(Includes Gestational Diabetes)

BRFSS 1995-96

Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

Diabetes Trends* Among Adults in the U.S.,

(Includes Gestational Diabetes)

BRFSS 1997-98

Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

Diabetes Trends* Among Adults in the U.S.,

(Includes Gestational Diabetes)

BRFSS 1995

Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

Diabetes Trends* Among Adults in the U.S.,

(Includes Gestational Diabetes)

BRFSS 1999

Source: Mokdad et al., Diabetes Care 2001;24:412.

Diabetes Trends* Among Adults in the U.S.,

(Includes Gestational Diabetes)

BRFSS 2000

Source: Mokdad et al., J Am Med Assoc 2001;286:10.

Diabetes Trends* Among Adults in the U.S.,

(Includes Gestational Diabetes)

BRFSS 2001

Source: Mokdad et al., J Am Med Assoc 2001;286:10.

COSTS?Dollars and Human Suffering

• 129 million U.S. adults are overweight or obese which costs this Nation anywhere from $69 billion to $117 billion per year.

• 2000, an estimated 17 million people (6.2 percent of the population) had diabetes, costing the U.S. approximately $132 billion.

• Heart disease and stroke - 2003 alone, 1.1 million Americans had a heart attack. Cardiovascular diseases cost the Nation more than $300 billion each year.

• 23 million adults and 9 million children have been diagnosed with asthma at some point within their lifetime, with costs near $14 billion per year.

What are some strategies to cope with increased medical costs?

• Consolidate health plans

• Pass costs to employees

• Health Reimbursement Arrangements (HRA’s)

• Wellness and Disease Management

What is health and wellness?

Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. (World Health Organization)

IllnessIllness Health Health WellnessWellness

PathogenPathogen SalutogenSalutogen

Holism, Holistic Health, Health Promotion, Wholism, Prognostic Health, Preventative Medicine

Wellness counseling is the science and art of helping people change their lifestyle to move toward a state of optimal health. Optimal health is defined as a balance of physical, emotional, social, spiritual, and intellectual health.

Wellness Counseling Definition

Historical Context of Wellness Paradigm

• Ancient Greeks - Asclepius• Cartesian Dualism yields reductionism• German Gestalt Psychology• Alfred Adler – “striving” for superiority• Abraham Maslow – Self-Actualization• H. Dunn - “High Level Wellness”• Stress and Immunity Research• Market for Alternative Medicine• Private Industry, Insurance, Government

Characteristics of A Wellness Model

• Holistic and Integrative• Persons oriented • Developmentally all inclusive• Quality and Longevity of Life• Positive Wellness• Proactive• Cross Cultural - Universal• Eclectic Approaches and Methods

Lifespan Model of Wellness

Witmer & Sweeney, 1991

LifeSpan Model of Wellness

Life Tasks

LifeSpan Model of Wellness

Life Tasks• Spirituality• Self-Regulation• Work - Leisure• Friendship • Love