This is a response to a class discussion. I will post the question at the top and my response below. Please feel free to comment and let’s keep the discussion going!
Why have Americans and their health care professionals been slow or resistant to address the core factors that contribute to Cardiovascular Disease, such as stress, poor diet, unhealthy environments, sedentary lifestyles, and isolation? Consider this question from a “zoomed out” societal standpoint, as well as on an individual level. As practitioners, how can we bring about change? How might you change the structure and content of your typical patient or client session to include aspects of Ornish’s approach? Consider the VA's integrative health program's recommendation for lifestyle change in addition to other factors.
I think the answer to these questions is really loaded and complicated. Intertwined with politics, big pharma, knowledge prejudices, resource scarcity, and a general lack of knowledge. In the early courses of the CIT program, we studied the implications of the Flexner report and how it has forever changed the way medicine is practiced in the U.S. With this change technologies in medical diagnosis’ and treatment has grown exponentially however in that growth was lost the basics of a healthy lifestyle.
“American medicine profited immeasurably from the scientific advances that this system allowed, but the hyper-rational system of German science created an imbalance in the art and science of medicine” (Duffy, 2011).
To briefly touch on the politics of the matter there are a couple of factors at play. There are food deserts in many urban areas around the country limiting the availability of fresh nutritional food options. Tulane University has an amazing website that details what a food desert is and how it affects the local population. It is estimated that in 2009 2.3 million Americans ("Food deserts in America," 2020), live in a food desert. Several factors such as distance to the market, transportation to the market, and price of food at the market are some of the biggest factors that contribute to the difficulty in obtaining fresh and nutritious foods. It becomes easier and less expensive to stop at the fast-food restaurant on the corner than take the bus to and from the market. Another piece of politics twisted into the puzzle is big pharma that fund politicians and lobby to sway in their favor. This could be seen as recently as the beginning of the COVID pandemic when Bill and Melinda Gates were on several major national tv networks speaking to the pharmaceutical companies they were ‘donating’ money to all while mentioning the political leaders involved as well. Just a quick google search suggests millions of dollars spent on lobbying. The deals that are made in government directly correlate to the recommendations that are sent out for the public. For example, let’s consider the food pyramid – the following is from an article in TIME magazine (Heid, 2016).
“Some experts contend the discrepancies between the two documents are, at least in part, the result of industry influence. “The current system opens the guidelines up to lobbying and manipulation of data,” says Dr. Walter Willett, chair of the Department of Nutrition at Harvard School of Public Health, when asked why the Advisory Committee’s report is subject to changes from USDA and HHS. “The USDA’s primary stakeholders are major food producers and manufacturers,”
An article published by the International Journal of Health Services published a similar article in 1993. Collectively we know this happens and it influences the way our food is grown and manufactured through industry leaders like Monsanto, how it is transported, where supermarkets are placed, and what types of markets are placed in which neighborhoods. It is a complicated mess.
Resulting from the political influencing, there is a knowledge deficit that exists both in medical professionals and the general public. I do think as integrative medicine practices are becoming more mainstream and easier to access such as massage, acupuncture, yoga, and mediation, these services are able to reach more people. For example, there are really great mediation apps that are free and can be played on the smartphone. Though that does not reach everyone it a lot more encompassing than the food desert.
I think the American way of conquering everything by myself has swung the pendulum too far and we (collectively as a society) are running ourselves ragged. Thinking of this on a very individual/personal level: My husband and I are both small business owners (different businesses), we have 4 small children, 3 of the 4 are trying to learn virtually at this time. They continue with extra circular activities several nights a week. Both my husband and I try to remain physically active several days a week but he enjoys heavy lifting and I’d prefer a long run or yoga so making time that each can get that needed break time is hard. Our days are long and planning healthy meals especially for the two of us while out running around is incredibly hard. We do better for the kids. It’s the typical all-American household – and it is really hard to not be stressed, eat well, get rest, and feed your soul. I do think one of the blessings of the COVID shutdown has been being forced to slow down a little and cooking again. To re-evaluate what is important in our individual families.
As practitioners, we are responsible for helping people to slow down. Explain to them the effects that life has on the body. Relaying the information in Dr. Bessel van der Kolk’s book the body keeps score and how to use CAM modalities to heal the body. Explain that chronic inflammation can create a perfect storm for cardiovascular disease when coupled with a sedentary lifestyle and poor diet. And how each of those exacerbates the other. In my personal business, I will send out newsletters or post a small video that briefly explains a health concern. For example, the video ‘From the Wings to Center Stage: How inflammation triggers a multitude of diseases’ briefly explains what inflammation is and then the effects. Also making it personal to the person helps to provide an understanding of why they need to change. Offering constant small nuggets of information that is relative to their I have found to be the best way to create change (Gardner, B., Sheals, K., Wardle, J., & McGowan, L., 2014). Ornish’s approach is brilliant and not an unreasonable diet to follow. I think inflammation is something most people suffer from especially if they consume the SAD. A diet that limits the inflammatory causing foods but maximizes nutritional value will absolutely provide the healthy change needed for overall health improvement.
The integrative approach of the VA system is a model that is continuing to evolve but one to strive towards in practice. We would do our clients an injustice if we only recognized one umbrella. The union between the traditional western model must be complemented with the integrative therapies that CAM provides because I believe you cannot help the client if you are only focused on the disease. We must consider the entire person through and through. A sincere consideration for heart and soul must also be made when treating a disease process. Fluid, not mechanical.
