Moving Towards a Health-Centric Healthcare Model with Salutogenic Science
America has a $4.3 trillion healthcare system that doesn’t produce health, said David Rakel, MD, at the Academy of Integrative Health and Medicine (AIHM) 2023 conference: Building Bridges to Whole Health in San Diego, Calif.
“And how did we get here?” Rakel continued. “Because instead of creating health, our healthcare system follows a “find-it fix-it” model focused on putting out fires rather than preventing them.”
In his presentation, Rakel, the professor and chair of the Department of Family and Community Medicine at the University of New Mexico School of Medicine in Albuquerque, New Mexico, argued that the healthcare of the future should be based on salutogenic science, with value-based, pro-active, health-centric care.
“Salutogenesis is an art based on science," Rakel said. Unlike pathogenesis, which is linear and focused on finding a specific problem with a direct solution, Salutogenic is based on patterns. Rakel explained that salutogenisis looks at a patient in their entirety, their behaviors and environment, and identifies a unique pattern, bending science to fit the individual’s needs best.
“I like to say we are all ecologists because we see the complexity, the breadth of that biopsychosocial spiritual communal model that we all live in,” said Rakel. “If we first start with the leaf, we're not going to see the forest.”
When treating a patient, practitioners must look at their health concerns broadly. All living things are influenced by their ecosystem and the way they interact with it, Rakel explained. “We can’t facilitate health without looking at the whole environment,” he added.
Today, with rapidly advancing wearable technologies and artificial intelligence, practitioners can gain more insight into their patients’ health measures and daily behaviors than ever before, Rakel explained. The technologies themselves will not be what changes healthcare, explained Rakel; instead, healthcare will advance as a result of how the technology is used, Rakel explained. Used in the right way, these technologies have the potential to enhance patient care with more personalized, holistic treatment approaches.
Creating health starts with a whole-food diet, Rakel said. While nutrient-dense organic fruits and vegetables can significantly improve health outcomes, unnatural, processed foods can cause great harm. Products like high fructose corn syrup, partially hydrolyzed trans-fatty acids, cross-hybridization, and non-nutritive sweeteners have been linked to diseases such as type 2 diabetes and stroke, Rakel explained. "Every time we've tried to manipulate nature, we've failed," he said.
Instead of looking to pharmaceuticals to treat conditions like type 2 diabetes, the salutogenic model encourages a holistic view of a patient, identifying modifiable risk factors that can be reduced through diet and lifestyle changes. Something as simple as adding fiber to the diet of patients with type 2 diabetes can reduce their A1C by 0.58 percent, Rakel explained.
Even those genetically predisposed to certain conditions can significantly reduce their risk of developing diseases through simple lifestyle modifications. Rakel explained research has shown that people with genetic risks for heart disease who implemented all seven lifestyle improvements, including no smoking, optimal weight, nutrition, movement, blood pressure, lipids, and blood sugar, lived an extra 20 years compared to those with the same genetic risk who made no behavioral changes.
The value-based, health-centered approach to medicine not only improves health outcomes but it also saves money, explained Rakel. “Around 30 percent of healthcare is a waste: that’s a trillion dollars of potential profit,” he said.
According to Rakel, keeping people healthy is what’s ultimately profitable, not costly treatments. And this may be the biggest incentive for the healthcare paradigm to shift away from the find-it fix-it model towards value-based care.
“I'm getting a little cynical as an old timer, Rakel said. “But if you want to change your culture, you have to change what you're paying for.”
Editor's note: This article is part of our live coverage of the 2023 Academy of Integrative Health and Medicine Conference. Click here for a list of full coverage.