The Past of Wellness
The History and Future of
Health Promotion and Wellness
Bill Hettler, MD
My first introduction to the topic of wellness and health
promotion actually occurred in May of 1969, while sitting in the commencement
exercise at the time of my graduation from medical school.
I had the good fortune to be sitting in the front row of the commencement
activities. After some initial
introductions, an older professor was assisted to the podium in front of the
platform committee. He was
introduced as John Phair, M.D.
In our four years of medical school education, we had
never before seen Dr. Phair. He was
a professor of preventive medicine. This
specialty had very little presence in the medical school curriculum.
We spent the majority of our time learning about disease and treatment
Dr. Phair began his presentation by saying, "You
boys (not gender sensitive, but, after
all, there were 2 women in our class of 100), will save more lives, and
alleviate more suffering if you never enter the practice of medicine."
At this point, there were audible groans from the audience.
He went on to say however, that if we would spend our time helping people
learn how to live instead of practicing traditional medicine, we would indeed
save more lives and alleviate more suffering.
I have to admit that at that point in my career, I did
not see the wisdom of Dr. Phair's words. It
is almost 30 years since I heard Dr. Phair give his sage advice.
I have since learned that what people do for themselves in the way of
lifestyle choices has a much greater impact on their chances of survival than
anything physicians are likely to accomplish.
My medical school training at the University of
Cincinnati College of Medicine was traditional in the late 1960s.
We never studied healthy people. We
were more interested in diseases and the treatment of same. I actually had 12
hours of medical education focused on one disease.
This disease is called pheochromocytoma.
Even though I had had 12 hours of medical education
focused on that particular disease, in my 30 years of medical practice I have
yet to see my first case. I keep
looking, hoping that those 12 hours were not in vain. In our traditional medical training, we were taught to ask
each patient, "what is your chief complaint". If the individual did
not have a chief complaint, we thought they were wasting our time.
Throughout history there have been philosophers, medical
researchers, and social leaders who had a clear idea about the importance of
promoting the correct way to live. Some
have given this approach the unusual name "orthobiosis".
The strict translation of this word is “correct living”.
This issue is not a moral focus, but is actually based on centuries of
direct observation as to which behaviors tend to enhance living.
One of the first leaders in the modern era of the
wellness concept was a physician who served as the director of the University
Health Service at the National University in Australia.
The National University is located in Canberra, Australia.
Brian Furnass, M.D. was one of the principal authors of a book entitled
to, "The Magic Bullet, The Social Implications and Limitations of Modern
Medicine". Brian and his
co-authors had a clear vision that the practice of medicine relied too much on
the magic bullet and too little on assisting people with the more difficult task
of living well. Brian visited UWSP in 1975 while touring the top wellness
programs in the U.S. For the next 10 years there was regular communication
between Furnass and his colleagues in the U.S.
of the most important publications in the history of North American public
a booklet published by the Canadian Minister of Health,
Mark Lalonde, A New Perspective on the Health of Canadians.
In this publication Mr. Lalonde pointed out that the vast majority of the
premature death and disability occurring in Canada was the direct result of
choices people had made. This
information was widely disseminated through Canada and quickly passed across the
border to the United States. Public Health officials throughout the United
States began to look critically at the materials and the conclusions of this
report. Ironically, much of the scientific research done to document
the findings in this report were created by American health officials working
for the Centers for Disease Control in Atlanta.
soon after Lalonde’s report was published, the public health officials in the
United States issued the Forward Plan
for Health. This was
published in June of ’75, but was designed to influence the years ‘77 to
‘81. Later, the U.S. Surgeon General’s report entitled Healthy
People was published, which
emphasized many of the same points made in Lalonde’s publication.
of the major efforts to come out of the Healthy
People document was the clear
that smoking had become the most important public health problem
Americans. It had greater impact on premature death and disability than any
modifiable risk factor. The history
of smoking in America is very interesting.
smoking involved pipes and cigars. Cigarettes
were considered something a
would use. They were hand-rolled
and relatively expensive. Real men
in the later part of the 19th Century, a brilliant engineer named
a cigarette rolling machine. This
was adapted from a wool feeder of a carting
and it replaced 48 hand rollers. This
was the beginning of a major industry that
had major detrimental effects on the public health of American citizens, and for
citizens throughout the world.
early on in the tobacco experience were very helpful in marketing tobacco.
Surveys were done and physicians, not yet being privy to the research findings,
were very accommodating to assist with the advertising campaigns.
magazine ads would say, “More doctors smoke camels than any other
Morris produced its famous “An Ounce of
Prevent Is Worth A Pound Of Cure” ad.
ad stated, “Philip Morris are scientifically proved far less irritating to the
nose and throat.” I have to ask, “Less irritating than what?
Sulfuric acid? Hydrochloric acid, sulfur dioxide?”
famous sports figures and other public figures would pose with tobacco products
and unfortunately many of them succumbed to the use of these products.
and Social Change. Advertising
Age is a trade publication of the ad industry.
If you’re at all interested in the efforts being made to change
American behavior, this is an important publication to read. The best psychologists in America and the most creative minds
on behavior change do not work in our clinics and hospitals, they work for
advertising agencies. Let’s
review some of the successful efforts of the past.
the early 1930’s, a brilliant executive working for a tobacco company
discovered that half of the American adults were not smoking and there really
was no reason why they couldn’t become smokers. So an industry-wide campaign
was developed to try to get women to smoke.
One of the first ads designed to encourage women to smoke was an ad from
Lucky Strike. In that ad the woman
is not actually smoking herself. That
would have been too big a jump from the cultural norms of the time.
Psychologists even in the early 30’s knew that it would not be
productive to show a woman smoking, when that was not culturally acceptable. One
of the other companies that produced Chesterfield cigarettes, created ads that
showed a young woman asking her male smoking friend to “Blow
Some My Way.”
the tobacco industry hired famous movie stars, opera singers, and women that
were socialites in the major cities, to
pose with tobacco products and talk about things such as “Not One Singe Case Of Throat Irritation Due To Smoking Camels.”
Isn’t it ironic that the #1 cause of throat cancer is this exact same product.
Americans are very familiar with
the successful Virginia Slims ads.
have helped women….…come a long way.
only Virginia Slims, but a number of other new tobacco products were created
specifically to attract the attention of women. These women-centered products have been very successful.
Lung cancer quickly became the #1 cancer for women.
physician by the name of Alan Blum, founded an organization named D.O.C. ,
“Doctors Oughta Care”. He and
his colleagues used outrageous anti tobacco ads to raise public conciousness
about the use of tobacco and its effects on public health. This was another important entry in the use of promotional
In United States in the early 1960’s, a little-known
public health official by the name of Halbert Dunn, M.D., Ph.D., began to
collect a series of presentations he gave under the title "high-level
According to Don Ardell, the founding father of Wellness
is the late Halbert L. Dunn. Ardell
has recommended that just as seminarians read the Bible, so future students of
high-level Wellness will seek the original publication on Wellness written by
Halbert Dunn's original book is a collection of 29 short
talks on key aspects of Wellness. This
is Dunn's definition of Wellness, "an integrated method of functioning
which is oriented to maximizing the potential of which an individual is capable,
within the environment where he is functioning."
Dr. Dunn's book is listed among Ardell's honor roll of
books. Ardell explains that Dunn
was aware of the works of major writers who have contributed so much to the
composite that is still becoming the Wellness lifestyle.
In Dunn's book he references the writings and ideas of Abraham Maslow,
Hans Selye, Carl Rogers, Gordon Allport, Eric Fromm, S. I. Hayakawa and Sydney
This final quote from Dunn outlines a vision that he had
for the future.
You, I, and our fellow man are emerging into a New World,
our world. In this New World,
science, faith, and the destiny of man blend with the oneness of life in the
alchemy of man's never-ending search for truth, as this search is carried on
throughout society in an energy field of responsive awareness, Love, and trust,
and is directed toward improving the world for mankind as a whole.
Later, Dr. Dunn decided to publish his collection of
presentations under the book title "High-level Wellness".
This book had a significant impact on a number of people in the Baltimore
area. One of those people was a
young physician by the name of John Travis.
John was enrolled in a preventive medicine residency program at Johns
John was very impressed with the ideas presented in
Halbert Dunn's book. About this
same time Dr. Travis was also exposed to the concept of health hazard appraisal.
This was a futuristic oriented methodology that had been developed by Lou
Robbins and Jack Hall, two physicians associated with the Methodist Hospital of
Indiana. Lou and Jack later wrote a
book entitled, "How to Practice Prospective Medicine". This book was the first organized effort at using national
center for health statistics data, along with patient histories, to compute an
estimation of future risk of death and disability.
Lou Robbins and Jack Hall recognized early in their
health promotion efforts, that if physicians were going to have a significant
role to play in lifestyle improvement activities, it would most likely be
delegated to other staff within the medical clinic. Listed below are some quotations from the "How to
Practice Prospective Medicine" handbook.
Extending life expectancy in improving the
individual’s survival chances cannot be said to be a simple task.
The family physician cannot and will not drop his or her concern for the
sick patient in order to provide a prognostic survey.
Every leader has a support team to help carry out
the task at hand. In prospective
medicine, the staff job has evolved to the health appraiser.
After five years experience in perfecting mechanics of the new medicine,
we have found that the staff assistant is the key to practicing prospective
medicine. The concept crystallized
in 1966. It was a simultaneous development of appraisers at the Methodist
Hospital and Jefferson Medical College. Miami
University soon followed.
At first, it appeared that only registered nurses
could be entrusted to carry out the functions required -- interviewing the
patient, assisting in history, completion and following through with motivation
techniques and counseling. But a
shortage of professionally trained personnel pose a problem for prospective
medicine, as it has caused difficulties to all of medicine.
As a result, we have developed health appraisers from persons with varied
educational backgrounds. A proposed
curriculum for the training of an appraiser is presented in part 3 of this book
Selection of the individual to fulfill the role of
appraiser is made by the managing physician.
Ideally, the appraiser is someone who the physician trusts, an employee,
serving under his or her supervision.
The physician is no stranger to risk.
For every patient he or she sees, there is a built-in
alarm system which warns the physician that his or her patient is carrying a
high-risk. Without the information
received in medical school on risk of death and disability, the physician would
find it impossible to practice medicine. By
the same token, ten-year risk in the absence of disease is knowledge the
physician must have if one is to counsel the patient on survival chances beyond
If the physician cannot quantify risks in the individual,
then any priorities set for management of health care will be influenced by whim
and special-interest. Episodic or
crisis medicine is a locked in chain reaction, which holds the patient through
differential diagnosis, risk assessment, specific treatment and follow-up.
This is a quality control of the healing part; and inevitable direction
and advantage for the patient in the workings of the indications in medicine.
Prospective medicine is directed toward providing a locked-in chain reaction of preventive care in which the greater survival and manage possible is sought for the patient many practicing physicians claimed to do this automatically in their minds. We propose a system whereby the urgency is of total risk understanding the need for preventive care.
Professional football manager Vince Lombardi may
not practice medicine, but he performs his job with a high sophistication of
risk perception. In his book,
"run to daylight", Lombardi discussed what it is like when the
pressure to win is on. The week
after the Green Bay Packers beat the Chicago Bears by an overwhelming score,
Lombardi was fried via sports writer for playing it "too safe". With the Packers leading the 42-20, Lombardi refused to
gamble on short yardage. He punted
on fourth down. Sports writer Bud
Lee complained, "Mr. Lombardi risks nothing."
Lombardi bristled. He shot
back, "isn't that winning is always all about?
All your effort in any business should be directed to taking the risks
out of it."
Lombardi's logic is appropriate to medicine, too.
Taking the risks out of living is the business of medicine.
It is the goal of prospective medicine.
Life insurance medicine gamble on the life of a
patient after making a brief examination. Although
the insurance company does not updated data for the policy under question, and
lays down to bet that is estimate of risks is fairly accurate port leased
ten-year periods. Insurance firms
can neither update did data nor reduce plan risk.
Yet, a trillion dollars of life insurance is now in force.
The relative accuracy of life insurance medicine has been
largely ignored by the physician. Physician
preoccupation with existing disease has capped M.D. is from seeing the
opportunity of updating risks and moving to reduce them in selected cases.
In life insurance medicine, the client is compared to a
standard risk: the chances of individuals of the same age insects who have known
permits. The competitive nature of
the business demands demonstration of the degree to which the individual differs
from standard risk. Then, who ever
offers the best rates generally makes the most sales.
The insurance underwriter adjusts rates according to the
risk characteristics of the client. Yet
the basic premise of life insurance medicine goes on exploited.
Prospective medicine, identifying a patient's total risks
as defined by the actuary, proceeds in the direction of risk appraisal and risk
reduction. It begins before disease
and injury with the quantitative estimate of the patient's own risks and
establishes priorities for their reduction. In practice, the family physician may well become the agent
of the future who extends insurance medicine by updating risks and extending
useful life expectancy. Unless we
can quantify risks in individual, as an M.D. is certain to do in the treatment
of cancer, we may be selecting a solution to the problems without first
About this same time, John Travis began to work on a book
that was entitled, "The Wellness Workbook".
This book was used in workshops conducted by Dr. Travis at his wellness
resource center located in mill Valley, California.
Dr. Travis attracted quite a bit of attention because he made it clear he
was not all interested in treating disease.
He was interested in helping people improve their lives.
His focus was multidimensional and positive in its approach.
Just as Maslow, the famous psychologist, suggested that we focus on what
is right about people as opposed to their deficiencies, Travis suggested we
focus on optimal well-being and assist people in the pursuit of same.
About this same time, there was a young Ph.D. candidate
who developed a self-directed doctoral program focused on positive health.
This young man was Don Ardell. One
of Don's first jobs was to be a health planner.
Don became frustrated when he realized that most of his efforts were
actually organized around the issue of providing disease care for people with
problems. Don was influenced by the work of Halbert Dunn and John
Travis. Don ended up writing a book
with the title, "High-level Wellness, An Alternative to Doctors Drugs and
Disease". This book, and Don's
flamboyant style, launched a career that has spanned more than 30 years.
John Travis and Don Ardell conducted workshops
throughout United States and other countries.
During the early 1970s, the physicians at the university health service
at the University of Wisconsin-Stevens Point began to use computerized lifestyle
assessment instruments as part of the entrance health requirements for the
university. The University
Wisconsin Stevens Point had a student development focus which had been
introduced by UWSP President James Albertson.
Albertson had the idea that a University should assist students with
learning how to live their lives as well as prepare them for some future career.
Here is an account by Bob Bowen, Ph.D. Bob, an
Indiana University health educator, was the Chair of the HPERA department at
UWSP during the early years of Wellness.
Every time I see Bill Hettler I can't help but think of what his life would have been like if I hadn't gotten bitten by the Wellness bug one night in Indianapolis back in spring 1971. The infection that followed resulted in the Jack Hall and Lou Robbins’ material on Prospective Medicine being sent to Dr. Don Johnson, then head of the UWSP Health Center, which more or less moved us into the early Wellness era. What does this have to do with Bill Hettler? Well, I have a hunch that when Don Johnson and I went to the American College Health Association Convention in Atlanta in 72, where Bill Hettler was interviewed, the idea of Prospective Medicine and then Wellness, influenced a decision toward a physician that was open to more than the traditional medical model for college students. Bill's transformation to a Wellness Physician was his own doing, but nonetheless a very interesting process to observe. I had a rather close-up view of it all.
Before becoming Chair of HPERA in 1972, I had the privilege of working in the WSU Health Center as their health educator for a semester. I had more or less free reign to develop and implement a few things that have lasted, namely the creation of the Student Advisory Board and helping to transplant some clinical/prevention ideas from the Indiana University Health Center where I had worked in the same role for more than a year while earning my degree. The Triage/Cold Clinic and lots of self help health enhancement brochures were examples. Being whisked out of the Health Center and into HPER administration set the stage for some other Bill Hettler happenings. It didn't take long before both Bill and Mary Fleischauer showed up in HPER (the Dept. of HPER became the School of HPERA about this time) classes and were even on payroll before I departed in 1977. By that time Bill was fully inoculated with the Wellness stuff and was off on his own so the down side of what happened in HPERA soon after didn't slow the Wellness Movement at UWSP. I should mention too that during this time we had hired the soon to be architect of the Sentry Employee Wellness Program, Ron Cook, which didn't hurt Stevens Point's claim to being the rising Wellness Capitol of the country.
Being out of the decision-makers position in August 1977 and with lots of Wellness stuff still in the works, an interesting turn of events took place. I needed a summer job in 78 and there weren't many options so one afternoon Bill Hettler and I sat down to brainstorm a possible Wellness Conference. We each went home that afternoon with the job of creating a program and logistical scheme for a national conference, or you might say come up with some pregnant ideas on how to keep the Wellness ball rolling. After just one night's gestation the National Wellness Conference was born, the 3rd Annual Wellness Conference, no less. Since we had sponsored two local Wellness Workshops under my administration as Associate Dean of HPERA which was part of Ron Cook's summer responsibility, we were not completely dishonorable in calling this first National Conference the 3rd annual gathering at UWSP. And, there was no other such event in the country so who could complain. The staging of that event is a story in itself, but we had the Governor, the Mayor, the Chancellor and other dignitaries on stage to open the event which must have been reasonably successful because what transpired these last 17 years has had more than a modest impact on many more lives than just Bill Hettler. Possibly yours included.
Just recently I read something about Dennis Elsenrath in the local paper which cited his rise to Wellness fame. It reminded me of a comment he made at the inaugural 1978 National Conference which he attended as an observer along with Fred Leafgren, no less, and in the heat of things as I was running helter-skelter (Bill Hettler was in Frost Valley, New York with a YMCA camp program and didn’t arrive til later in the week) the comment was, “You’ve really done a great job with this conference, Bob.” My comment; “Oh, we’ll see after it’s over.” Dennis: “Don’t be afraid to take credit for something, will you!” Well, something must have gone well because it was almost immediately decided that this sort of conference should be an annual event and we needed a special committee to put it on. That happened and the Wellness Conference Planning/Coordinating Committee was created and served for several years before the Wellness Institute and Dave Emmerling took over. The unplanned budget for the first conference was over $10,000 and was really a Continuing Education based event, since Barb Inch (different name then) handled the housing and budget matters for us. There were no special meals the first year because we just had no idea what was going to come out of that first effort. We did have recognition programs and maybe a talent night, can’t remember for sure, but it was an interesting gathering of neophytes in the Wellness business from schools, hospitals, workplaces and you name it. Even Hans Diehl from Loma Linda, California representing the Seventh Day Adventists, who were then the healthiest sub-population in the US, was there. Jim Fiegelson was Mayor, Martin Schrieber was Governor and Lee Sherman was Chancellor. Wisconsin and Stevens Point were rightfully the emerging capital of Wellness.
The University became a one of the early leaders in the
use of health hazard appraisal and prospective medicine.
In the early 1970’s Mary Fleishauer, one of the nurses from the
University health service in Stevens Point, traveled to California to
participate in a wellness workshop conducted by John Travis. Fleishauer returned
to Stevens Point from the workshop convinced that there were some valuable
concepts being presented in the wellness workshops.
She persuaded Don Johnson, the director of the university health service,
to purchase materials from John Travis. This
was the first introduction of wellness materials to the city of Stevens Point.
About this same time, Bill Hettler, M.D. began work on
the Lifestyle Assessment Questionnaire. This
was a lengthy questionnaire, which had a number of sections including, a
wellness inventory, a health hazard appraisal, a medical alert section, and a
section in which the user could select information on topics for personal
growth. The first version of this
questionnaire was computerized and made available nationwide.
Later, Dr. Hettler requested assistance from two colleagues at the
University Wisconsin. Dennis
Elsenrath and Fred Leafgren, two doctoral level. psychologists agreed to assist
with the second edition.
The L.A.Q. began to generate interest from other parts of
the country. People began to ask
for training related to the use of the L.A.Q. and other health promotion
techniques. About this time, Dr.
Hettler became the director of the University health service.
One of his friends and colleagues, Robert Bowen, Ph.D. voluntarily step
down from administrative position he held at the University.
The new chairman of his department reduced the summer teaching
availability for Dr. Bowen. Following
a conversation between Hettler and Dr. Bowen, a suggestion was made to hold a
national conference on the subject of wellness promotion strategies.
Since Dr. Bowen and Dr. Hettler had been part of 2
workshops the previous two summers, they decided to identify the next conference
as the Third Annual Wellness Promotion Strategies Conference.
A brochure was quickly created and mailed to a wide variety of mailing
lists throughout United States. Hettler
and Bowen were very surprised that more than 250 people registered for the
This was the beginning of the National Wellness
Conference. The conference has
continued to grow over the years to the point that it attracts 1600 people each
summer. In the early years of the
national wellness conference, a large number of participants made yearly
requests that the organizers of the conference create a membership organization
for those professionals who enjoyed participating in the yearly conferences.
After two or three years of encouragement, the Institute assisted with
the creation of an organization called, "Organization of Wellness
The Organization of Wellness Networks was a precursor to
the National Wellness Association. The
National Wellness Institute was initially named the Institute for Lifestyle
Improvement. Initially, all
financial services for the Institute were provided by the Foundation at the
University Wisconsin-Stevens Point. Later,
as the revenues continued to stream into the National Wellness Institute from
its various activities, the Board of Directors of the university foundation
requested that the National Wellness Institute split off from the foundation.
The main reason behind this request was that the Institute was generating
large amounts of revenue which had to be treated as unrelated business income by
the foundation. The foundation
board felt that this might compromise the tax-exempt status of the foundation.
In June of 1985, the Board of Directors of the
organization of wellness networks issued the following letter
Four years ago, participants at the national wellness
conference indicated a strong desire to establish an organization that would
provide networking for those committed an interested in wellness.
There was a desire not only to have an organization, but a desire as well
for services to members. The
services that were desired included newsletters, publications, resource
information etc. the organization of wellness networks (OWN) was established and
during this period of time the officers and Board of Directors initiated
activities which were indicated as desired by the members of the association.
Computer rise membership lists, a newsletter in a journal were created
during the past three years. We do
a great deal to Jan Berry-Schroeder and Leon Rottman for their assistance and
contributions in developing the newsletter and journal, respectively.
There is a general consensus among the officers of the
association of 0WN and the Board of Directors that we have not accomplished the
other objectives to anywhere near the degree desired, and that the turnover of
officers and lack of a permanent office and staff have hindered this process.
It is our believed that OWN member needs can best be provided by an
established organization or group that can offer the other services that are
really necessary if we are to meet the initial goals that were desired and which
brought about the organization of wellness networks.
This has been discussed extensively during the past year by the officers,
and we're making the following proposals which will be considered at the annual
meeting of the Organization of Wellness Networks which will take place during
the National Wellness Conference July 20 through 27th.
We propose the following:
organization of wellness networks be dissolved
existing balance of funds be transferred to the national wellness association.
members of OWN, if they join the national wellness association, will receive the
journal free for one-year period
OWN members endorsed the board's recommendation to have the NWI provide
membership services in lieu of 0WN.
We are enclosing literature describing what the
national wellness association is prepared to offer.
The officers believe that the initial goals we had when establishing 0WN
can be met by this type of operation. It
is our strong desire to have a viable organization that can serve us in a
variety of capacities. The National
Wellness Association is now staffed with three full-time professionals with
additional support staff these individuals can, on an ongoing full-time basis,
provide the services that will give us the type of program and offerings useful
to professionals involved in wellness activities.
These recommendations are presented to you now for your consideration.
They will be voted on at the conference.
We will look forward to senior there.
Fred Leafgren, President-elect
Dennis Elsenrath, Past president
Sandy Queen, President
About the same time that the national wellness
association was evolving, another national group was also developing.
This group of professionals evolved from among the leaders of fitness
programs that had been established in business industry.
The initial name selected by this group was, "The American
Association of Fitness Directors in Business and Industry".
This name was abbreviated AAFDBI.
Most of the major corporations in the United States
had begun to recognize the positive benefits of exercise and health promotion
activities by the year 1980. Throughout
the 1980s and '90s there has been a continuous expansion of health promotion
efforts in the workplace. Some of
the major leaders in corporate health promotion were,
Johnson & Johnson
AAFDBI held annual meetings, developed a journal,
developed regional associations, and a number of other services to members.
An honorary fellow recognition program was created to recognize
significant leaders in the field of corporate health promotion.
AAFDBI later changed its name to the Association for
Fitness in Business or AFB for short. After
a few short years being known as AFB, the association again changed its name to
the Association for Worksite Health Promotion.
This evolution in name changing is reflective of the changing mission for
professionals working in corporate health promotion.
The initial organization was very focused on fitness as
its major activity. Beginning in
1976, the association began to expand its mission to include a broad range of
health promotion topics. Today the
association meetings focus on a broad range of topics similar to those presented
at the National Wellness Conference.
The Association for Worksite Health Promotion has
developed a strong network of regional associations. These regional organizations provide training opportunities
on a more local basis.
A significant amount of research has been done under the
leadership of members of The Association for Worksite Health Promotion.
These studies have been published in a wide variety of professional
journals. The Association for
Worksite Health Promotion has its own journal but another important journal that
has evolved is The American Journal of Health Promotion.
This journal has a large volunteer editorial staff
representing a broad range of health promotion professionals.
This journal has become one of the most important publications in the
field of wellness and health promotion. Any
serious research involving wellness and health promotion can usually be found in
the American Journal of Health promotion.
There is a fundamental change that is occurring within
the field of health promotion. This
change involves the massive investment that is being made to create health
promotion assessments and information. The
delivery of these assessments and content via the information superhighway will
have a dramatic impact on the ability of the average person to assume greater
responsibility for their health and well-being.
As I look to the future, I am optimistic and excited.
One of my early heroes was Buckminster Fuller.
Bucky, as he was known to his friends and admirers, had a vision that
someday people anywhere in the world would be able to listen to the best
teachers on any subject, 24 hours a day, in their own home, in the language of
The technology to make that happen exists as we
close out the 20th century. While
we may still have serious problems with access to certain parts of the world,
this too will change overtime. Our
efforts in health promotion have been relatively unsophisticated until recent
times. Most of the time, health
promoters were simply telling people to do things that they are ready knew they
should do and many cases wished they were able to do.
As we develop more sophisticated tools to assist us
in identifying the specific personality type and learning preferences of our
clients, we can improve on the success rate for those clients seeking assistance
in extending useful longevity. The
merging of the yields of telecommunication, educational technology, micro
processing, and low-cost video production will enhance the resources available
to assist with lifestyle change.
Physician directed medical self-care can be
delivered through a variety of systems. Some
of the systems include:
The Internet and World Wide Web
Audio tape systems
Automated fax back systems
Computerized decision support software
Dedicated medical self care television networks
Topic specific online chat rooms and forums
Newsletters and journals
It is this author's opinion that the most dramatic and
least expensive delivery system will involve the Internet and the World Wide
Web. Almost all the other resources
listed above can be delivered more efficiently through the use of the Internet
and World Wide Web. Michael
McDonald, MPH, a health and human ecology director for the Environmental Science
and Policy Institute, has predicted that communication speed will grow by a
factor of 10 million and computing power will increase by a factor of 10,000 by
the year 2003. He suggests that
when these two figures are multiplied together the combination will produce
machines a billion times more powerful than those that exist today.
As the medical profession becomes more comfortable
with computer technology and other audiovisual delivery systems, this massive
increase in processing power and storage capacity can assist us in our goals to
improve the quality of life and lower the cost of care for the patients we
serve. For the time being, the
Internet and World Wide Web seem to be the most efficient delivery system.
This chapter in fact is being written using voice
recognition software. At this point
in the article, I have been using regular conversation that is recognized
efficiently by the software, which then places the words directly on the screen.
While I am creating this document, I can switch back and forth to
resources on the World Wide Web or physically present in the form of books and
journals on my desk.
The dramatic reduction in the cost of CD-ROM
recorders, video capture technology, and multimedia editing software have made
it possible for individual physicians, nurses, and patient educators, to create
their own multimedia self-care resources. A
CD-ROM recorder can be purchased for less than 500 dollars.
For about the same amount money, a video capture device can be installed
in a home computer. This device will enable the user to capture video clips that
have been developed privately by the user or purchased from professional
sources. Using multimedia-editing
software, that often is included with the video capture device, one can create
customized patient education materials.
The cost of blank media for CD ROM production is
less than two dollars per disk. Capturing
images electronically by using scanners, digital cameras, and video cameras is
commonplace in many American grade schools.
This author has personally observed third graders capturing and editing
videotape information. They were
successful in creating educational materials that could be used by other
students anywhere in the world. This
is an enormous step forward.
Just 10 years ago the cost of creating videodisc
interactive technology was greater than one hundred thousand dollars per topic.
When it comes to educational technology, there are hundreds of companies
actively working to create user-friendly software that physicians can use to
create practice specific physician directed self care materials.
The emphasis today on chronic disease care management and demand
management will drive greater utilization of these resources in the larger
The use of microcomputers to create customized
videotape resources is also a reality as this chapter is written.
This also is a grade school skill in many locations.
As the students in our schools today begin to graduate and seek jobs, it
will be realistic for the larger clinics to include customized videotape
production as one of the expectations in the job description of health educators
or medical self-care leaders.
Each day in America, there are hundreds of
high-quality video productions created by news programs in local television
stations. Many of these programs
could be captured, cataloged and stored for later use by medical self-care
production facilities. Obviously, a
system must be created to give proper credit and compensation to the original
producers of such materials. The
ability of current technology to manage a database of these resources makes this
a feasible concept.
Audiotape production has also enjoyed significant
technological advances. Microcomputers,
high-quality microphones, and editing software make it possible for any health
care provider to create customized decision support audio tapes that can be
given into the patient to reinforce the instructions or procedures recommended
for the care of their problems. The
cost of such production is minimal. The
duplication cost of audiotapes is also minimal.
Another innovation that can work in many locations
is automated fax back systems. There
are turnkey systems available that enable a medical office or clinic to provide
automated patient information at very low cost. The systems are easily customized and can be managed by
clerical staff. The health
professionals must create the content, but once this content is created,
patients can easily access instructions or materials of their choice through fax
There are similar automated systems that involve
voice messaging. Many of the
systems enable the user by the use of touch tone input, to select specific
information of their choice. This
technology is also cost-effective and is being used particularly in the
technical support area of computer companies.
Logical tree structures are created that enable the user to be quickly
moved to the resources that will assist them in solving their problems.
This same procedure can be used to assist medical patients in finding the
answers they need to make decisions in a self-care mode.
The future is coming.
We can’t stop the accelerated rate of change. We can, however, choose how much we personally embrace the
acceleration. I will close this
piece with a quote from a book entitled ‘The Adventures of David Grayson”.
“The Burden Of The Valley Of Vision”
I came here eight years ago as the renter of this
farm, of which soon afterward I became the owner. The time before that I like to forget. The chief impression it left upon my memory, now happily
growing indistinct , is of being hurried faster than I could well travel.
From the moment, as a boy of seventeen, I first began to pay my own way,
my days were ordered by an inscrutable power which drove me hourly to my task.
I was rarely allowed to look up or down, but always forward, toward that
vague Success which we Americans love to glorify.
My senses, my nerves, even my muscles were
continually strained to the utmost of attainment. If I loitered or
paused by the wayside, as it seems natural for me to do, I soon heard the sharp
crack of the lash. For many years,
and I can say it truthfully, I never rested.
I neither thought nor reflected. I
had no pleasure, even though I pursued it fiercely during the brief respite of
vacations. Through many feverish
years I did not work: I merely
The only real thing I did was to hurry as
though every moment were my last, as though the world, which now seems so rich
in everything, held only one prize which might be seized upon before I arrived.
Since then I have tried to recall, like one who struggles to restore the
visions of a fever, what it was that I ran to attain, or why I should have borne
without rebellion such indignities to soul and body.
That life seems now, of all illusions, the most distant and unreal.
It is liked the un-guessed eternity before we are born:
not of concern compared with that eternity upon which we are now
All these things happened in cities and among
crowds. I like to forget them.
They smack of that slavery of the spirit which is so much worse than any
mere slavery of the body.
One day - it was in April, I remember, and the soft
maples in the city park were just beginning to blossom - I stopped suddenly.
I did not intend to stop. I
confess in humiliation that it was no courage, no will of my own.
I intended to go on toward Success:
but Fate stopped me. It was
as if I had been thrown violently from a moving planet:
all the universe streamed around me and past me.
It seemed to me that of all animate creation, I was the only thing
that was till or silent. Until
I stopped I had not known the pace I ran; and I had a vague sympathy and
understanding, never felt before, for those who left the running.
I lay prostrate with fever and close to death for weeks and watched the
world go by: the dust, the noise,
the very colour of haste. The only
sharp pang that I suffered was the feeling that I should be broken-hearted and
that I was not; that I should care and that I did not. It was as though I had died and escaped all further
responsibility. I even watched with
dim equanimity my friends racing past me, panting as they ran.
Some of them paused an instant to comfort me where I lay, but I could see
that their minds were still upon the running and I was glad when they went away.
I cannot tell with what weariness their haste oppressed me. As for them, they somehow blamed me for dropping out.
I knew. Until we ourselves
understand, we accept no excuse from the man who stops.
While I felt it all, I was not bitter.
I did not seem to care. I said to myself: “This is Unfitness.
I survive no longer.
So be it.”
Thus I lay, and presently I began to hunger and
thirst. Desire rose within me:
the indescribable longing of the convalescent for the food of recovery.
So I lay, questioning wearily what it was that I required.
One morning I wakened with a strange, new joy in my soul.
It came to me at that moment with indescribable poignancy, the thought of
walking barefoot in cool, fresh plow furrows as I had once done when a boy. So vividly the memory came to me - the high airy world as it
was at that moment, and the boy I was walking free in the furrows - that the
weak tears filled my eyes, the first I had shed in many years.
Then I thought of sitting in quiet thickets in old fence corners, the
wood behind me rising still, cool, mysterious, and the fields in front
stretching away in illimitable pleasantness.
I thought of the good smell of cows at milking - you do not know, if you
do not know! - I thought of the sights and sounds, the heat and sweat of the hay
fields. I thought of a certain
brook I knew when a boy that flowed among alders and wild parsnips, where I
waded with a three-foot rod for trout. I
thought of all these things as a man thinks of his first love.
Oh, I craved the soil. I
hungered and thirsted for the earth. I
was greedy for growing things.
I thus, eight years ago, I came here like one
sore-wounded creeping from the field of battle. I remember walking in the sunshine, weak yet, but curiously
satisfied. I that was dead lived
again. It came to me then with a
curious certainty, not since so assuring, that I understood the chief marvel of
nature hidden within the Story of the Resurrection, the marvel of plant and
seed, father and son, the wonder of the seasons, the miracle of life. I, too, had died: I
had lain long in darkness and now I had risen again upon the sweet earth.
And I possessed beyond others a knowledge of a former existence, which I
knew, even then, I could never return to.
of David Grayson
1925, by Doubleday, Page & Company
All rights reserved. Printed in the
United States at the Country Life Press
Garden City, N.Y.