Wellness at RMITPioneering a New Academic Discipline

Prof Marc CohenMBBS(Hons), PhD(TCM), PhD(Elec Eng), B.MedSc(Hons), FAMAS, FICAE, Dip Ac

Program Leader, Master of WellnessFoundation Professor of Complementary Medicine, RMIT University

A stable health system

Wellness Activities

Acute care

Intensive care

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$General care

General care

Wellness

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Current health system

$ Acute care

General care

Wellness

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Current health system

$ Acute care

It’s going to fall over

All is not well with the world

Pan Books, London (1972).

All is not well with the world

• http://dieoff.org/page25.htm

Climate Change“Climate change represents the greatest and widest-ranging market failure ever seen”

“Business as usual is not an option”

A 1% pa investment will prevent a 20% decline in global GDP

Toxic Pollution

http://www.worldwildlife.org/toxics/basic.cfm

• 70,000 toxic chemicals are now in commercial use and around 1,000 new chemicals enter the market every year

• POPs are found everywhere on the planet -in our food, soil, air and water.

• Combinations of toxins may combine to have greater effects than single toxins

• Wildlife and humans around the world carry POPs in their bodies at or near levels that can cause injury.

Radioactive waste

• High level waste may be radioactive for many millions of years and increases by about 12,000 tons/yr

•A number of incidents have already occurred where radioactive material was disposed of improperly, shielding during transport was defective, or when it was simply abandoned or even stolen from a waste store

www.marathonresources.com.au/nuclearwaste.phpwww.greenpeace.org.uk/media/press-releases/greenpeaces-response-to-corwmwww.iaea.org/Publications/Magazines/Bulletin/Bull413/article1.pdf

Toxic bodies

A 1995 study found breastfed infants in Victoria were regularly exposed to DDT and other pesticides at levels greater than the Acceptable Daily Intake (ADI) set for adults

[1] Quinsey PM, et al. Food Chem Toxic 1995;33(1):49-56

© Prof Marc Cohen

Wealth Inequality

Kevin Carter 1994 Pulitzer Prize for photography

http://qazse.files.wordpress.com/2006/12/starving-hand-2.jpg The World Distribution of Household WealthWorld Institute for Development Economics Research of the United Nations University

• The richest 2% own more than 50% of global wealth.

• The poorest 50% of adults own barely 1%

• Wealth inequality for the world is estimated to be as if one person in a group of ten takes 99% of the total pie and the other nine share the remaining 1%.

• Globally, there are more than 1 billion overweight adults

• In the US the number of overweight children has doubled and overweight adolescents has trebled since 1980.

• Obesity and overweight pose a major risk for chronic diseases, including type 2 diabetes, cardiovascular disease, hypertension and stroke, and certain cancers.

www.stuffedandstarved.orghttp://www.who.int/dietphysicalactivity/publications/facts/obesity/en/

Obesity Epidemic

World hunger

Kevin Carter 1994 Pulitzer Prize for photography

• The WHO estimates that 1/3 of the world is well-fed, 1/3 is under-fed 1/3 is starving.

• 3 billion people in the world today struggle to survive on US$2/day.

• Every 3.6 seconds someone dies of hunger

http://library.thinkquest.org/C002291/high/present/stats.htm

Rampant Consumerism

Consumers have access to a seemingly unlimited choice yet are disconnected from the products and services they purchase.

Depression and insomnia are at epidemic proportions

Unchecked and unconscious consumption is at the root of many world problems

Chronic Disease

Of the 58 million deaths in the world in 2005, 35 million (60%) will be caused by chronic diseases such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes.

The main modifiable risk factors for these diseases are lifestyle related and include unhealthy diet, physical inactivity and tobacco use.

What is wellness?

• The constant, conscious pursuit of living life to its fullest potential

• A state of high consciousness where you can be fully present in the moment and where actions flow naturally and authentically from the ‘deep inner well of your being’

• The state where you look, feel, perform and stay ‘well’ .

• Wellness enable you to experience the greatest fulfillment and enjoyment from life and achieve the greatest longevity.

What is wellness?

Wellness is a holistic and therefore has multiple dimensions including:

- Physical - Psychological- Sexual - Emotional- Social - Cultural- Spiritual - Educational- Occupational - Financial- Environmental - Ethical- Political - Existential

www.globalspasummit.org

The Global Wellness Industry Cluster

Enhanced healthIll health Average health

I L L N E S S

Western Medicine

Complementary Medicine

AVERAGE

HEALTH

ILL

HEALTH

ENHANCED

HEALTH

W E L L N E S S

Flexibility of response

PERFECT HEALTH BLISSBlissors

Stressors© Prof Marc Cohen

Basic Philosophical Concepts of TCM

Tao

Chi

5 elements

Yin Yang

Bu/Xie

∞

Evolution/Entropy

Balance

Transformation

Flow

Experience

© Prof Marc Cohen

© Prof Marc Cohen

Negentropy gradient

Transformation

Balance

Entropygradient ΔS > 0

Entropy bandwidth

Flow

ExperienceBliss∞

ΔS = 0

Wellness and entropyWellness is a state of minimal entropy production

Anabolism CatabolismConsumption CreationChallenges CapacityBeing Doing

• Stress management• Exercise• Nutrition• Social / Spiritual interaction• Education

Wellness Activities (Blissors)

The future of healthcare

“There is growing evidence that the current health systems of nations around the world will be unsustainable if unchanged over the next 15 years.”

“Consumers will be play a much larger role in healthcare”

“Preventive care and disease management programs have untapped potential to enhance health status and reduce costs.”

Most people in the west die of a broken heart

© Prof Marc Cohen

Coronary Artery Disease

Normal open artery

Thickened scarred and

narrowedAlmost

complete blockage

(Treatment 1) (Treatment 2)

• 8% ↓ blockage • 28% ↑ blockage

• 91% ↓ pain • 186% ↑ pain

• 50% ↓ in hospitalisations & deaths

• Safer & reduces other diseases

• cost $400 • cost $40 000

Which therapy would you choose?

• Low fat vegetarian diet

• Moderate exercise

• Stress management training

• Group support

Ornish, D. et al. (1998) JAMA, 280(23): 2001-7

Intensive lifestyle change

it is considered CONSERVATIVE to;• strip a vein from the leg • open the chest • place the vein across a blocked artery• repeat the procedure every 10 years

it is considered RADICAL to; • relax • exercise • eat good food• share your feelings

In the current health system

LOHASLifestylesOfHealthAndSustainability

In 2006 LOHAS consumers spent $300 billion, representing approximately 30% of the USA consumer market

LOHAS

• Prevention of disease/ageing

• Optimising health/performance

• Deficiencies in conventional medicine

• The need to invest in wellness

Public are increasingly aware of:

General dietary recommendations

•Seasonal

•Locally produced

•Organic

•Whole foods

‘Conshumanism’“Conscious and humane consumption”

“Consumption with maximal awareness, efficiency and enjoyment and minimal pain, energy, waste and pollution”

‘Conshumanism’“Conscious and humane consumption”

When consuming ask :• What is in it?• Who made it?• Where is it from?• How did it get here? • Who benefits from the sale?• What use is it - is it worth it? • What is its lifecycle and embodied energy?• What is its environmental & social impact?• What are the alternatives – do I really need it?

?

To see the world in a grain of sand and heaven in a wild flowerHold infinity in the palm of your hand and eternity in an hour

-William Blake

© Prof Marc Cohen

Flow

"a joyous, self-forgetful involvement through concentration, which in turn is made possible by a discipline of the body".

-Mihalyi Csikszentmihalyi

© Prof Marc Cohen

C H

A L

L E

N G

E S

S K I L L S

Anxiety Arousal Flow

Worry

Apathy Boredom Relaxation

Control

© Prof Marc Cohen

New Vocations

• Wellness coach • Workplace wellness director• Positive psychologist• Spa practitioner• Permaculturalist

© Prof Marc Cohen

Professional Issues

• Confidentiality• Ethical conduct• Adverse event reporting• Complaints handling• Continuity of care • Contact management• Privacy and e-Records• Billing and 3rd party payers• Referral base

© Prof Marc Cohen

• Education • Continuing Education• Evidence base• Research strategy• Professional indemnity• Scope of practice • Conflict of interest• Code of practice • Renumeration levels

Presenteeism vs Being present

No-one wants to go to a hospital but everyone wants to go to a good hotel

Towards a global health service

© Prof Marc Cohen

Wellness Research ?

Sustainable ‘barefoot’ luxury

Six senses resort Hua Hin

Natural swimming pools

Earthship biotecturePermaculture Living water flowforms

Wellness Design

“ access to nature plays a vital role in human health, wellbeing, and development that has not been fully recognised .”

“ . . . the positive effects on human health, particularly in urban environments, cannot be over-stated.”

Connection with nature

Healthy Parks Healthy People; A review of relevant literature. Maller & Townsend et al 2008

Connection with animals

Contact with companion animals has multiple positive physiological and psychological effects on human health including: – decreasing blood pressure, heart

rate, and cholesterol; – reducing anxiety and stress and

providing protection against stress-related diseases;

– provision of companionship and kinship;

– and the opportunity to nurture.

All of these factors improve quality of life and enhance health and wellbeing.

Healthy Parks Healthy People; A review of relevant literature. Maller & Townsend et al 2008

© Prof Marc Cohenwww.iso.org/iso/en/networking/pr/cartoons/pages/measurement.html

If you don’t measure . . . you can’t manage

If you don’t state . . . you can’t communicate

Australian Unity Wellbeing index

• Subjective measure of wellbeing

• 19 national surveys since 2001

• Concept of wellbeing homeostatic set-point

http://acqol.deakin.edu.au/index_wellbeing

Adult normative range

76.3

73.3

77.9

74.7

69.4

74.2 73.874.4 74.3 74.0 75.7

77.1

78.3

64

66

68

70

72

74

76

78

80

12&13 14&15 16 17&18 19-25 26-35 36-45 46-55 56-65 66-75 76+

Strengthof

satisfaction

Age group

SWB across the lifespanSWB across the lifespan

Dr Adrian Tomyn RMIT University

Quality-Adjusted Life Years (QALYs)• Quality of life is both objective and subjective.

• Objective domains are measured through culturally relevant indices of objective well-being

• Subjective domains are measured through questions of satisfaction

• QALY equal 1 for each year of full-health life, less than 1 for various degrees of illness or disability

• Cost-effectiveness of treatments can be assessed by the cost per QALY

© Prof Marc Cohen

Disability-adjusted life years (DALYs)

Measures of burden of disease

DALY = Years of Life Lost + Years Lived with Disability

1990 WHO report indicated that

5 of the 10 leading causes of disability were psychiatric conditionswhich account for 28% of all years lived with disability, but only1.4% of all deaths and 1.1% of years lost.

Thus, psychiatric disorders, while generally not seen as a majorepidemiological problem, are shown by consideration of disabilityyears to have a huge impact on populations.

© Prof Marc Cohen

BankWest Quality of Life Assessment based on:

• Home ownership • Detached housing • Employment • Income Levels • Broadband Internet Access

• Proportion of Empty Homes in an area • Volunteering Rates • School enrolments for sixteen year olds • Proportion of the Population in Good Health • Property related crime rates

Triple Bottom Line Reporting

• John Elkington, who coined the phrase in 1994, has defined the TBL approach as:

“At its broadest, the term is used to capture the whole set of values, issues and processes that companies must address in order to minimise any harm resulting from their activities and to create economic, social and environmental value. This involves being clear about the company’s purpose and taking into consideration the needs of all the company’s stakeholders.”

© Prof Marc Cohen

Happy Planet Index

www.neweconomics.org

Wellness Measures

Wellness includes

• Subjective wellbeing/happiness

• Physiological status - HRA

• Social capital /connectedness

• Ecological footprint

• Security and socioeconomic status

Wellness Footprint

“Develop a Wellness Footprint to evaluate measure and resource services . . . and drive a prevention agenda.”

Research Questions

• How do we measure wellness? What is a “Wellness Footprint”

• How can different measures be used to assess levels of disease, disability and performance?

• What interventions or policies are most likely to maximise wellness for individuals, businesses and communities?

Want to learn more?

www.rmit.edu.au/wellness

Want to learn more?

www.rmit.edu.au/wellness

Includes courses on:•Leadership & Management•Global Business Context•Corporate Wellness•Wellness Coaching•Lifestyle Management•Positive Psychology •Mindbody Wellness•Aromatherapy •Herbs & Supplements•Food as Medicine •Energy Medicine Cross credits available for UC Irvine Spa Management Course

Pessimism and Optimism• Pessimists -

– GOOD EVENT - external, temporary, specific, (Them, Then, That)– BAD EVENT - personal, permanent, pervasive, (Me, Always, Everything)

• Optimists -– BAD EVENT - Then, That, Them– GOOD EVENT - Always, Me, Everything