Decreasing health and the public’s increasing awareness—chronic disease incidence.
There are concerning trends of chronic disease in the United States. Most recent data show that 48.6 percent of Americans have some form of cardiovascular disease. Approximately 43 percent of the U.S. is obese, and roughly one in 10 have diabetes. All of these are on the rise, as is the awareness of the suboptimal state of health care.
COVID-19 spurred many changes in how Americans view their health and what they can do to change it. The COVID era produced many profound changes in how Americans view their health. Here are three examples:
First, increased awareness of underlying diseases causing worse outcomes. As it became clear that patients with underlying diseases like diabetes, heart disease and autoimmune disease suffered worse outcomes from COVID-19, media coverage and mental health campaigns about these conditions expanded dramatically.
Second, the increasing prevalence of chronic disease is becoming mainstream. The growing rates of chronic disease mean that everyone is affected, or someone close to them is, making it more visible than ever. According to the Centers for Disease Control and Prevention (CDC), six in 10 Americans have a chronic disease, and four in 10 adults have two or more. This year, one in three children born will develop diabetes. Chronic disease has reached epidemic proportions in the U.S.
Third, the growth of patient advocacy groups. Due to patients gathering and sharing information online, their advocacy is stronger than ever. Long COVID was identified and described primarily through patient experiences; it may be the first condition to be recognized and named outside the mainstream medical system. Before patient advocacy, some long COVID sufferers were told they had psychological illnesses rather than physiologic ones. This is similar to the experiences of fibromyalgia and chronic fatigue syndrome patients, other “invisible” chronic diseases for which treatment protocols do not easily apply. It is primarily through patient advocacy that gains in awareness and funding for these conditions have been brought about.
Growing Demand for Health Education
The Institute for Natural Medicine (INM) is meeting the public’s increasing interest in trustworthy and reliable information on addressing chronic disease, which is also rising due to increased awareness. In January, we shared information on the epigenetic effects of nutrition in pregnancy to the development of chronic disease through an article by Dr. Kent Thornburg entitled “The Impact of Early Life Experiences on Long-Term Health” and a live webinar on “The Power of Nutrition for a Healthy Start.” Dr. Thornburg’s work has proven the outsized impact early life nutrition and environment have on late-life chronic disease. His work confirms the need for a greater role and prominence for health care professionals whose education and training are deeply rooted in clinical nutrition and diet to be at the front lines of health care (complementary and integrative health care). CIH providers represent a qualified and ready fit.
Growing Demand for CIH
Similar to the interest in education, there is a desire for access to CIH providers. This moment of whole-person health is reflective of the rising demand for holistic health care approaches. The use of CIH disciplines is strong and growing.
From the 2022 National Health Interview Survey, we learned that 19.2 percent of Americans used at least one of the seven CIH professions, whereas in 2022, 36.7 percent of people did. Increased demand for some of these professions was striking:
• Naturopathic medicine increased 650 percent
• Yoga therapy increased 316 percent
• Meditation increased 230 percent
• Acupuncture increased 220 percent
• Chiropractic increased 145 percent.
These are important indicators of the healthy and growing demand for CIH.
Coherence Among CIH Disciplines
CIH professionals are focused on whole-person health and most are experienced in the strategies of using food as medicine and the importance of nutrition, making their inclusion in the health care system more imperative than ever. A shared coherence can be found among the professions included in the CIH sector. Some common framework elements include:
Holistic Assessment
• Viewing the person as a whole rather than focusing solely on symptoms
• Considering physical, mental and emotional factors while respecting patient values and choices.
• Evaluating lifestyle and environmental factors
Prevention-oriented
• Emphasis on maintaining health and preventing disease
• Early intervention when imbalances are detected
• Patient education and engagement in self-care strategies
Individual-centered
• Individualized treatment plans
• Recognition that similar symptoms may require different approaches
• Consideration of patient preferences and lifestyle
Therapeutic Relationship
• Strong emphasis on practitioner-patient partnership
• Shared decision-making
• Extended consultation times compared to conventional medicine
There is more agreement and overlap among these approaches than separates them. While distinct disciplines within the CIH professions can be incorporated into treatment plans, these different strategies exist within a unifying framework of understanding. There are many paths to healing. The most appropriate and effective care is one that resonates with the patient’s values and leads to compliance. Or, in other words, patient-centered whole-person care.
Research as an Essential Aspect of the Path Forward
The RAND Research Across Complementary and Integrative Health Institutions (REACH) Center is a visionary approach to help the CIH educational institutions access federal research funding with greater success, which has historically been more easily accessed by conventional medical academic institutions. The CIH institutions cannot develop their research infrastructure without this funding. They will continue to experience a “brain drain” as their best and brightest researchers must leave those institutions to access NIH (National Institutes of Health) research dollars. This may be one reason that some of the CIH health care delivery models have not been well researched and are not influencing healthcare policy and decision-making today. INM and the National University of Natural Medicine’s (NUNM) Helfgott Research Institute were awarded a RAND REACH pilot grant to develop a process to explore whole-health outcomes data through electronic health records, starting with ten primary care naturopathic clinics.
Back to the example of long COVID. Once recognized, patients demanded that research be initiated to help solve this chronic health condition. The NIH spent more than $1 billion last year on long COVID research. Unfortunately, no novel treatment approaches were identified, and no patients were enrolled in trials during this year. This is an excellent example of how curiosity about the CIH fields could accelerate understanding of chronic disease, specifically long COVID. Many CIH practitioners have successfully treated patients with long COVID. I am one such practitioner. In my last case, the treatment plan was very individualized and incorporated a whole-person approach, including understanding and working with the patient’s genetics, diet, mental health and exercise. This plan would not work for every long COVID patient, which is precisely the challenge for conventional research methodology and its value.
By exploring the wisdom and therapeutic framework of CIH professions, we stand to gain a new approach to chronic disease—one that can stand the test of time because, in fact, it already has. This is precisely why the field is enjoying strong and growing demand.
Our Moment to Expand
The potential to shift our health care system to one that focuses on prevention depends on many factors: the public recognition that health care needs to improve, available models of whole-person health care that can integrate into care streams, and the funding and will to produce compelling research data to support the efficacy of these models. To ensure that the whole-person health moment is meaningful to our health care system, we must increase the visibility and reputation of provider types who are currently practicing whole-health to the public at large; we must unify the CIH sector and present a compelling and actionable solution. This is why INM is expanding its mission in 2025: to bring whole-person health mainstream.
INM is utilizing its educational and messaging expertise, laying the groundwork to help make the case that CIH disciplines are valuable and practical models for whole-person health. The CIH community has a once-in-a-generation opportunity to share its most impactful theories and practices of medicine to influence health care delivery and policy. To achieve this, we must be united in our messaging, collaborate with allies in the mainstream, and lean into the growing evidence base that supports these strategies, particularly in the case of chronic disease.
Combining bold research strategies with powerful messaging alignment is an essential step to help unify the CIH field and present it as a serious solution to the health crises in our nation. The time to come together is now. In this chaotic moment, we must be laser-focused on natural medicine’s core power and promise, and INM stands ready to help us all become stronger together.
Michelle Simon, PhD, ND President & CEO, Institute for Natural Medicine
In 1992, the leadership core of naturopathic doctors established the Institute for Natural Medicine (INM) as a not for profit organization dedicated to advancing natural medicine. The purpose of the INM is to increase awareness of, broaden public access to, and encourage research about natural medicine and therapies. Among its milestones the INM counts the launch of the Association of Accredited Naturopathic Medical Colleges (AANMC) as an independent organization, leading California’s efforts to obtain licensure, developing an interactive childhood education program focused on healthy eating and lifestyles called Naturally Well in 2017, and expanding residency access by establishing and funding a residency program in 2018. INM has joined forces with the American Association of Naturopathic Physicians (AANP), serving as the charitable arm, to deepen access to naturopathic care, public education and research. Dr. Michelle Simon serves as president and CEO of INM, is a licensed naturopathic physician, clinician, educator and leader in many organizations dedicated to improving the quality and delivery of health care. In addition to holding a naturopathic doctorate from Bastyr University, she also holds a PhD in Biomedical Engineering from the University of North Carolina at Chapel Hill. Dr. Simon has served on the boards for the Integrative Healthcare Policy Consortium (IHPC), the AANP and the Naturopathic Physicians Research Institute (NPRI). Dr. Simon also served nine years on the Washington State Health Technology Clinical Committee which is part of the Health Technology Assessment program that examines the scientific evidentiary basis for efficacy, safety and cost effectiveness of health care technologies. She was also an invited participant for health care economics at “Summit on Integrative Medicine and the Health of the Public” at the Institute for Medicine (IOM) in 2009. Dr. Simon was recognized as the 2018 Physician of the Year by the AANP.
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