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2 Defining Whole Health
Pages 33-58

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From page 33...
... The concept of whole health is not novel, and it has been evolving for decades under a range of different names such as salutogenesis, patient-centered care, people-centered care, integrated care, and population health (Anastas et al., 2018; Bhattacharya et al., 2020; Nash et al., 2016; National Committee for Quality Assurance, 2018; Stewart, 2014; Thomas et al., 2018)
From page 34...
... : Whole Health is VA's cutting-edge approach to care that supports your health and well-being. Whole Health centers around what matters to you, not what is the matter with you.
From page 35...
... Together these elements aim to create a "circle of health." (See Figure 4-1 in Chapter 4 for a more detailed discussion of the circle of health.) The circle includes four elements: the person, self-care, professional care, and the community.
From page 36...
... To achieve this, whole health care is an interprofessional, team-based approach anchored in trusted longitudinal relationships to promote resilience, prevent disease, and restore health. It aligns with a person's life mission, aspiration, and purpose.
From page 37...
... There is seamless coordination and provision of services across sectors and interprofessional1 care teams with a shared goal of helping people and communities achieve whole health. Moreover, whole health systems start by identifying how people, families, and communities define what health and well-being means for them and what they need to achieve it.
From page 38...
... . Thus, whole health is more than the absence TABLE 2-1  Foundational Elements of Whole Health People-centered Achieving a sense of purpose through longitudinal, relationship-based care People/families/communities direct goals of care Care delivered in social and cultural context of people/family/ community Comprehensive Address all domains that affect health -- acute care, chronic care, and holistic prevention, dental, vision, hearing, promoting healthy behaviors, addressing mental health, integrative medicine, social care, and spiritual care Attend to the entirety of a person/family/community's state of being Components and team members are integrated and coordinated Upstream-focused Multisectoral, integrated, and coordinated approach to identifying and addressing root causes of poor health Address the structures and conditions of daily life to make them more conducive to whole health Equitable and Whole health systems need to be accountable for the health and wellaccountable being of the people, families, and communities they serve Care needs to be accessible to and high quality for all Team well-being The health of the care delivery team is supported
From page 39...
... Achieving personcentered whole health is a process grounded in longitudinal relationships with team members and organizations that build shared understanding and trust over time. This includes relationships among individual clinicians, care teams, and health systems and the people, families, and communities for whom they are accountable.
From page 40...
... Empowering people with the tools, resources, and the environment to more easily adopt healthy behaviors is an essential component of whole health care. Whole health systems also need to address the social and structural determinants of health -- poverty, housing, food, finances, education, environment, equity, and racism -- which represent both the cause of poor health (social determinants)
From page 41...
... Team Well-Being Interprofessional teams deliver whole health. The team is organized around the person, family, or community and includes, based on needs, conventional health care clinicians, integrative medicine providers, and professionals from non–health care sectors, such as social services and education, spiritual, and financial areas.
From page 42...
... Clinician stress and burnout hurt not only clinicians but also patients, communities, health care organizations, and learners. Ensuring and enhancing the health of those who care for and support communities creates an engaged and effective workforce, high-functioning care teams, and healing person–clinician relationships.
From page 43...
... . In addition to the relationship between a person and his or her primary care clinician, there are a growing number of primary care practices in which clinicians work as part of an interprofessional team that may include behavioral health specialists, community health workers, health coaches, pharmacists, and others.
From page 44...
... They may also provide various services that focus on upstream factors including case management, referrals to specialty care and social services (many of which address root causes of poor health) , and transportation and translation services (National Association of Community Health Centers, 2022)
From page 45...
... People who go to health centers are also less likely to have delays in medical care or dental care than those who seek care elsewhere (National Association of Community Health Centers, 2022)
From page 46...
... Social and Structural Determinants of Health Social and structural determinants of health (commonly referred to as "social determinants" or "social needs") are the true reasons for health inequities and a whole health approach is key to addressing them at the population and community levels.
From page 47...
... In other cases, social risks may be the root cause of poor health. In all cases systems that aim to deliver care that is holistic, optimally aligned with patients' preferences, and focused on the whole person will, at a minimum, need to collect information about patients' social and structural determinants of health and equip the interprofessional care team to help mitigate social risks and are necessarily relevant to whole health care at both a person and system level.
From page 48...
... Whole health care aims to deliver care that is integrated and coordinated, not siloed. The integrated behavioral health movement has found that care is best "integrated" when delivered from a single location by co-located interprofessional team members who create a seamless experience for patients (Asarnow et al., 2015; Bokhour et al., 2020; Reiss-Brennan et al., 2016)
From page 49...
... , the Institute of Medicine described how community context is critical when dealing with the complexities of delivering high-quality primary care. It described communityoriented primary care as an approach to medical practice that undertakes responsibility for the health of a defined population, by combining epidemiological study and social intervention with the clinical care of individuals, so that the primary care practice itself becomes a community medicine program.
From page 50...
... . In addition, many community health interventions require policy, environment, community organizational, and social/interpersonal actions that only community partners can achieve (Ackermann, 2013)
From page 51...
... More importantly, this chapter provides a concrete description of the aspirational goals for systems interested in providing whole health, and the subsequent chapters provide a detailed roadmap with examples including successes and failures, challenges, and lessons learned from the whole health field. The universal definition defines what whole health is -- "physical, behavioral, spiritual, and socioeconomic well-being as defined by individuals, families, and communities." The definition also defines what a whole health approach is -- "an interprofessional, team-based approach anchored in trusted longitudinal relationships to promote resilience, prevent disease, and restore health.
From page 52...
... 2018. Building behavioral health homes: Clinician and staff perspectives on creating integrated care teams.
From page 53...
... 2014. Transforming from centers of learn ing to learning health systems: The challenge for academic health centers.
From page 54...
... 2014. Proximity of providers: Colocating behavioral health and primary care and the prospects for an inte grated workforce.
From page 55...
... Bethesda, MD: National Association of Community Health Centers. Schwenk, T
From page 56...
... 2013. The collaborative care model: An approach for integrating physical and mental health care in Medicaid health homes.
From page 57...
... The social stratification of health center governing boards. Health Expectations 18(3)


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