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Passport to Whole Health: Chapter 13

Chapter 13.  Prevention: Being Proactive

An icon of a person holding a light bulb signifying an idea.

Treatment without prevention is simply unsustainable.


―Bill Gates

Chapters 5-12 emphasize the importance self-care as part of Whole Health.  In this chapter and the remaining ones, we transition outward to the other parts of the circle.  The next circle moving out from the center is Professional Care.  While Veteran (and team member) self-care is fundamental to Whole Health approach, it is complemented—and shored up—by professional care.  It is important to take the time to discuss who is on a Veterans’ care team, emphasizing that they are their own team captains.  Veterans need people to empower and equip them with what they need to succeed, be it education, skill building, resources, or support. 

The Professional Care circle represents all the ways a person might receive help from others, be they conventional or complementary health practitioners.  Whether it is called “conventional medicine,” “biomedicine,” or “Western medicine,” the interventions offered within mainstream medicine have many potential benefits, and they are as much a part of Whole Health as the other Circle components.  Among these, prevention is of central importance.  Whole Health care must be proactive. 

The “one pill, one ill” or “find-it, fix-it” models of care have their place, but they do not work well for people with chronic disease.  These diagnosis-focused frameworks become particularly limiting if a person is living with more than one chronic illness.  It simply does not work to assume a treatment protocol for a given health problem will work for every person who has that problem.  Treating someone with a combination of diagnoses, such as fibromyalgia, irritable bowel syndrome (IBS), headaches, depression, psoriasis, diabetes, obesity, and hypertension (or sometimes even just one of those conditions) can often be challenging.  Ideally, it is helpful to have as many tools as you can.  Prevention, keeping the problems from ever happening in the first place, is the focus of this chapter.  Complementary and integrative health (CIH) is the focus of Chapters 14-18.

Proactive Care: Considering Prevention

Majority of life-threatening disease around the globe is now chronic and linked to health behaviors.[891]

It does not work to simply play a defensive game, to be in the mindset of responding only when problems arise.  Prevention matters greatly.  Consider the following:

  • Eliminating unhealthy behaviors would prevent 80% of cases of stroke, heart disease, and type 2 diabetes, and it would prevent 40% of cancers.1
  • A 2018 review of data from the Nurses’ Health Study and the Health Professionals Follow-up Study focused on the effects of five healthy behaviors: never smoking, body mass index of 18.5-24.9, moderate alcohol intake, high diet quality score, and ≥30 minutes daily of moderate to vigorous physical activity.[892]  Hazard ratios for people doing all five behaviors versus none of them were as follows: 0.26 for all-cause mortality, 0.35 for cancer mortality, and 0.18 for cardiovascular mortality.  Women who had none of the positive behaviors would be expected, at age 50, to live another 29 years; for men, that would be 25 ½ years.  People who practice all five behaviors would increase their years of life beyond age 50 by an average of 43 more years for women and 38 more for men.
  • A 2009 study followed over 23,000 people, noting the correlations between chronic diseases and the following four behavioral factors2: 1) more than 210 minutes a week of physical activity; 2) adhering to healthy diet principles; 3) never having smoked; and 4) having a body mass index less than 30.  After adjusting for age, sex, occupation, and educational status, people who met all four criteria had:
    • 78% lower risk of developing diabetes
    • 81% lower risk of heart attack
    • 50% lower risk of stroke
    • 36% lower risk of cancer
  • A Centers for Disease Control (CDC) analysis of statistics for Americans collected from 2008-2010 concluded that “…when considered separately, 91,757 deaths from diseases of the heart, 84,443 from cancer, 28,831 from chronic lower respiratory diseases, 16,973 from cerebrovascular diseases (stroke), and 36,836 from unintentional injuries potentially could be prevented each year.”[893]
  • 1/5 or 1/6 of all deaths in the U.S. are linked to tobacco smoking and hypertension.[894] 1/10 of deaths are due to being overweight or physically inactive.  Low fruit and vegetable intake is estimated to have led to 58,000 deaths in 2005.4
  • Exercise seems to be comparable to medical treatment for secondary prevention of coronary heart disease, prevention of post-stroke rehabilitation, and prevention of heart failure.[895]
  • In 2014, the CDC estimated that, in the U.S., “vaccinations will prevent more than 21 million hospitalizations and 732,000 deaths among children born in the last 20 years.”[896]  Measles vaccinations, given in 73 countries, will prevent 13.4 million deaths.  Providing nine other vaccinations in those countries will save another 9.9 million lives.[897]
  • 130 Americans die each day from opioid overdoses.[898] 

Prevention "Commandments"

The suggestions that follow are just a few of the prevention tips to consider during personal health planning.[899],[900]  Some of them might tie in with various self-care circles on the Circle of Health as well.  Each item on the following list can have marked long-term benefits for Whole Health, and many of them come from the VHA National Center for Health Promotion and Disease Prevention’s (NCP) Healthy Living Messages, which are described in detail at their website.9,10

  • Maintain a healthy weight.
  • Avoid excessive alcohol.
  • Be careful about fall risk, especially if you are over 65.
  • Brush and floss your teeth (prevents gum disease, which can be related to chronic inflammation in the body).
  • Do not operate motor vehicles when under the influence of any substances.
  • Do not take recreational/illegal drugs.
  • Don’t smoke or use tobacco in other ways.
  • Keep firearms unloaded and locked away.
  • Put carbon monoxide detectors and smoke detectors in your home.
  • Use safe sex practices.
  • Wear helmets when appropriate.
  • Wear your seatbelt.
  • Follow up with appropriate screening tests.
    • This includes cancer screening via mammograms, colonoscopy, Pap smears or other tests.
    • Review screening recommendations for your age with your care clinician during wellness visits, including any that are specific to you because of your family history. 
    • Screening may include lab tests like blood sugar, cholesterol, blood counts, or other measures your care clinician feels appropriate. 
    • Remember to have vision and dental screens as well.
  • Stay up to date on your shots.
  • Take your medications appropriately.

Another way to favorably affect the progression of chronic disease is through well-being interventions.  A 2019 study reviewed 34 articles (1,635 participants) and concluded that for type 1 or type 2 diabetes, an array of well-being interventions can have benefit for health outcomes; the challenge is that it is not yet possible to say whether any one particular well-being approach is superior to others.[901] 

A 2014 systematic review of 10 trials concluded that engagement itself “...should be quantified as part of a comprehensive risk appraisal given its apparent value in helping individuals to effectively self-manage chronic disease.”[902]  The review of 10 trials found that people with multiple chronic disease responded favorably to a variety of interventions to enhance engagement, with improved outcomes such as hemoglobin A1c, blood pressure, cholesterol measures, depression scores, and overall quality of life.  A 2017 review of 722 articles identified four key elements that are key to a person being engaged: 1) Personalization, 2) Access, 3) Commitment, and 4) Therapeutic Alliance.[903]  A healing environment also contributes.  Whole Health leaves room for care teams to offer all of these aspects of care.  In fact, caring for patients through more global models, with engagement as a focus, is central to the Whole Health approach. 

The NCP has links to recommended screening tests and immunizations for men and women (Refer to the Resources section at the end of this chapter for more information.)  On My HealtheVet, people can enter data about their behavior practices and risk factors to get an estimate of their health age (their age based on how much their health behaviors add to or take away from their life expectancy, in comparison with their actual age).

Remember, proactive care is fundamental to Whole Health.  Do all you can to keep people from developing problems in the first place.  It is all about primary prevention.  How often do you consider preventive mental health?  Or taking steps to preventing the development of chronic pain?  A preventive mindset can be useful, even when working with people who have a number of chronic illnesses.  Build and maintain skills, like Motivational Interviewing, that increase your ability to help others change their behaviors.  And remember, all of this applies to your own self-care as well.  What are you doing for yourself when it comes to preventive care?

Prevention Resources

Websites

VA Whole Health and Related Sites

Whole Health Library Website

Other Websites

Apps and Monitoring Software

The phone app listed below is free.  Free it by searching online or in your device’s app store.

Prevention TaskForce App
    .  U.S. Preventive Services Task Force Recommendations.
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