The Wellness Illness Continuum (see below) was developed by John Travis, MD in the 1970’s. I first discovered it during my very first month in practice back in 1990. It’s an extremely useful concept to share with patients interested in improving their health.
I ak patients to identify where along the Wellness Illness Continuum they fall with respect to their health, and where on the Continuum they would like to see their health. We then develop a plan to help them go from point A to point B.
What is Wellness?
We usually have no problem defining illness and we know it when we see it. But, we do struggle to define wellness. Frequently, we define wellness as the absence of disease. “I don’t have high blood pressure. I am not a diabetic. I don’t have cancer. Therefore I must be healthy.” But, being free of disease doesn’t mean you’re healthy.
I see many patients who are not sick. Yet they have low energy. They are not as focused as they once were. They are gaining weight despite maintaining the same diet and activity level. They experience mood swings. Some are depressed and not happy with their career or personal life. Basically, they don’t feel like themselves, or as good as they should.
Wellness is more than the absence of disease. It’s living life with a high level of energy. It’s having the physical and mental endurance to achieve your goals. It’s looking forward to the day and approaching it with vigor and vitality. It is taking advantage of the gifts we each have and applying them fully. Wellness isn’t about getting through the day. It’s about making the day. In short, high level wellness is “being all you can be.”
Where would you place yourself on this continuum and why? And, what can you do to move yourself further to the right on the Continuum? I suspect if we could plot where every individual would fall on the Continuum we would see a bell-shaped curve slightly shifted to the right of the neutral point. In other words, most individuals are only in fair health and are hovering around the neutral point.
The Continuum Explains How Healthcare Operates
There’s much more to the Wellness Illness Continuum than is apparent. It explains much of our current approach to healthcare. Traditional medicine encompasses the “treatment paradigm” to the left of the neutral point. Typically this is what health insurance covers. There’s not much that traditional medicine offers on the right side of the neutral point – maybe an annual preventive exam.
As Bill Maher said. “You see, there’s no money in healthy people, and there’s no money in dead people. The money is in the middle – people who are alive sort of, but with one or more chronic conditions.” Perhaps that is why traditional medicine focuses on the left hand side of the Continuum – that’s where the money is. However, if you rely only on traditional medicine you cannot achieve optimal health.
Great Health Requires Effort
As we go further to the left on the Continuum the patient takes on an increasing passive role while healthcare providers take on an increasing active role. The classic example is the patient in the intensive care unit. A ventilator is breathing for him. He’s being hydrated with an IV. He’s being fed through a G-tube. If his heart stops, the medical team will shock it back to work. And so on. The patient is doing very little to actually get better.
As we go further to the right along the Continuum, the patient or individual assumes more responsibility and takes on an increasingly active role in his or her overall health. The doctor takes on a more passive role, as he becomes more of a teacher or coach – the very definition of a doctor.
On the left side of the Continuum the doctor-patient relationship is very much one-sided. On the right side of the Continuum the doctor-patient relationship is more of a partnership, or teacher-student relationship.
Wellness-Illness Continuum: Real Life Examples
Let’s take a professional football player who is currently functioning at the far right of the Continuum. He then tears his ACL. In a fraction of a second (the time it takes to get injured) he goes from being extraordinarily functional to being disabled. He then has his ACL reconstructed. Where does the surgery move him? Back to the far right? Nope. The surgery only moves him back to the neutral point. The surgery removed his symptoms of instability of the knee. In and of itself the surgery does not get him playing football again. That comes through hard work by the athlete in conjunction with help from the physical therapists and athletic trainers.
Now let’s take a second case – that of a 50-year-old man who was slightly to the right of the neutral point and then has a heart attack. He gets a couple of stents for his coronary arteries that improve the blood flow to his heart. The procedure also only moves him back to the neutral point as the stents remove his angina (chest pain) symptoms. He then goes through cardiac rehabilitation and changes his diet and in doing so is able to move some where to the right of the neutral point.
Likewise, giving antibiotics to someone with pneumonia or a urinary tract infection also only gets a patient back to the neutral point – it removes their symptoms. It does not get them to a high level of wellness.
The point is: to get to the right of the neutral point takes patient effort.
Take Charge of Your Health
When you stop and think about it that’s the best conventional medicine can do – get you to the neutral point. If you want to get to the right of the neutral point you have to “take charge of your health” and find people who can help teach you how to accomplish that. But, in the end it’s ultimately up to you.
Your goal should be to get to right on the continuum as far as possible as you approach middle age. This will give you the “reserve” to weather the declines, some of which are inevitable, that come with aging. If you do that before those age-related declines occur you will find yourself still to the right of the neutral point as you age and not dependent on the healthcare system like so many experience. Your goal is to die healthy.
How do you get to the right of the neutral point? Better exercise and better nutrition are the keys. But, optimal wellness also requires optimal hormone levels. Optimal health and wellness are not possible without optimal hormone levels. Many can achieve high levels of wellness during their 30s and even 40s through exercise and nutrition (when their hormone levels are naturally healthy), but there comes a point for a majority where exercise and nutrition is not enough as their hormone levels decline. That’s where the help of a doctor is necessary to restore levels to healthy levels.
Newer developments to keep us on the right side of the Wellness-Illness Continuum are being developed, too. This includes stem cell treatments and products that activate stem cells to repair and regenerate the body, and products to increase telomere length.
It’s your life. It’s your health. Take charge!
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