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The first proponent of health promotion or wellness may have been Hippocrates himself ( Grossman 1983). When he and his medical students encountered an unfamiliar city, he would advise his students to become acquainted with the lifestyles of the local residents by noting their work patterns and eating habits.
The Young Men's Christian Association has been described as one of the oldest wellness organizations ( Grossman 1983). The triangular emblem of the Y.M.C.A., which symbolizes its dedication to mind, body, and spirit, was adopted in the early 1880s. Many wellness proponents today subscribe to the idea of the person as an interrelated whole consisting of mind, body, and spirit.
Edward Steiglitz, a Chicago physician and one of the grandfathers of the wellness movement, presented several novel ideas in his book, The Second Forty Years ( Steiglitz 1952). The human life span, he wrote, was being prolonged due to the control of infectious disease, scientific developments in agriculture, better methods of food storage and transportation that made good foods readily available, and a better understanding of nutrition and its relation to health. Because the proportion of older individuals in the population was increasing, Steiglitz was concerned that they not become a social and economic burden to society. He hoped that senior citizens would continue to render service to society and lead more fulfilling lives in doing so. While he did not deny the gradual impairments that might accompany the aging process, Steiglitz noted that improved hygiene, medical guidance, and "living in accordance with today's understanding of the nature of man" ( Steiglitz 1952, p. ix) could delay the onset of these impairments and decrease their severity. Although the prevention of disorders that accompany aging is important, Steiglitz felt that it was not enough.
To understand this point, we must look at the definition of health that was commonly accepted at the time: "that state of being, existing in the absence of disease" ( Steiglitz 1952, p. 14). This definition, Steiglitz wrote, was inadequate as well as negative in context. Health, he articulated, was a kinetic as opposed to a static state involving "reserve forces" that were hidden but nevertheless available. He described "perfect health" an an ideal that was probably never attainable; nevertheless, one must strive to attain it by using all available reserve forces.
Steiglitz recognized that it did not suffice to treat disease by reconstructing damaged health. Better health, he elaborated, could be worked toward "even in the absence of florid disease" ( Steiglitz 1952, p. 301). The means to achieve better health was coined "constructive medicine," which differed from preventive medicine in that the focus of attention was on the patient and not on the disease itself. Constructive medicine, nonetheless, included the notion of preventive medicine.
Steiglitz elaborated further on the differences between the terms. He viewed preventive medicine as having a negative connotation because prevention implied prohibitions or restrictions with the purpose of avoiding something that may prove harmful. Although avoiding the negative effects of noxious influences was viewed as beneficial, Steiglitz proposed that protective avoidance measures "do not actually improve the vigor and vitality of the individual" ( Steiglitz 1952, p. 30). Although removing hazards from the environment had certainly contributed to increasing the average life span, the problems of aging, he noted, "arise from within" and were associated with biological changes. Environmental controls would not serve to modify these biological modifications.
Constructive medicine, with its positive implications, had as its objective the attainment of optimal health for individuals. Because he regarded health as kinetic, "well" people could become even healthier. Steiglitz pointed out that it was common pediatric practice to provide guidance in nutrition, exercise, and living habits, and he questioned the merit of providing this information only for infants and children. Adults, as well, he noted, should be given the opportunity to improve their state of health. The benefits included improved vigor, greater work efficiency, enhanced endurance, increased resistance to infection, and more rapid recovery from illness.
Steiglitz believed the objectives of constructive medicine could be met with a number of methods. One of these methods was through gerontological research, which was necessary in order to answer perplexing questions about the biology of senescence and the causes of the disorders that often appear in the later years. Education, another method that Steiglitz proposed, was "intellectual nutrition." Education in health matters is essential if people are expected to follow suggestions in order to become healthier. On the preventive side, he noted that environmental controls to neutralize or remove health hazards were necessary. This type of preventive measure was a public health, en masse matter, but Steiglitz also advocated "individualized health construction." He recognized that in order to attain optimal health through constructive medicine, one had to focus upon the individual and his or her unique needs. Another grandfather of the movement toward healthier lifestyles was Halbert Dunn, M.D., Ph.D. Dunn may have borrowed some of the ideas proposed by Edward Steiglitz and his "constructive medicine." During the 1950s, Dunn, a public health official, gave radio talks on various aspects of well-being. High Level Wellness ( Dunn 1961) contained 29 short talks that Dunn had aired on radio. In this book, to characterize high level wellness he referred to the definition of health adopted by the World Health Organization: "Health is a state of complete physical, mental and social well-being, and not merely the absence of disease and infirmity" ( Dunn 1961, p. 1). Dunn agreed with this definition in that a complete state of well-being involves wellness of the mind, the body, and the environment, with the environment encompassing the family, community life, and a "compatible work interest." Like Steiglitz, Dunn agreed that being well did not simply refer to a state of "unsickness" and it existed in different degrees at various times. Simply stated, at times you may feel "more well" than at other times, without actually being "sick." An example might be when you experience a lack of energy or, conversely, when you "tingle with vitality." Dunn stated that most individuals, most of the time, find themselves at some point between the two extremes on this wellness continuum. Dunn found the state of wellness to be far more interesting than that of sickness and questioned why doctors, nurses, and health workers were preoccupied with disease, death, and disability. He postulated that an "illness" focus represented the medical training orientation toward disease rather than toward wellness. He noted also, as did Steiglitz, that wellness is not a static, homogeneous state, but rather a state that is ever changing. Dunn defined wellness in the following manner: High level wellness for the individual is defined as an integrated method of functioning which is oriented toward maximizing the potential of which the individual is capable. It requires that the individual maintain a continuum of balance and purposeful direction within the environment where he is functioning ( Dunn 1961, pp. 4-5).
Rather than striving for an optimum level of wellness, Dunn preferred to describe a "direction in progress toward an ever higher potential of functioning" ( Dunn 1961, p. 6). Dunn described his conception of the nature of man to demonstrate how we are, indeed, capable of achieving wellness based on his definition. Rather than viewing mind, body, and spirit as separate entities, he viewed the person as a total personality where mind, body, and spirit meld and function in an environment that constantly undergoes change. An essential element in achieving wellness, Dunn wrote, is a "purpose for living." Although Dr. Dunn's unique ideas did not stir much controversy at the time, two decades later they influenced John Travis and Don Ardell, the two fathers of the wellness movement.
While John Travis was a medical student and intern, he began to view medicine in a manner that was quite different from his contemporaries. He thought focusing on disease made medicine into an occupation of "disease care." Travis later read Dunn unique little book, High Level Wellness, which reflected some of his own thoughts ( Grossman 1983). Borrowing from Dunn's ideas while adding many of his own, Travis developed an illness/wellness model to demonstrate how health should be thought of as a positive state of well-being rather than the absence of illness. This was accomplished by using a continuum, with premature death and high level wellness at opposite poles. At the midpoint of the two poles was a vertical line to demarcate a neutral point where no discernable illness or wellness existed. Moving from the neutral point in the center to the left pole toward premature death, one would encounter signs, symptoms, and disability. According to Travis ( 1986), this is where one would find traditional medicine, whose purpose is to cure disease. Seldom did modern medicine progress beyond the neutral midpoint, he suggested. Moving along the continuum from the midpoint to the right pole toward high level wellness, you would find education, growth, and self-actualization. Travis's brand of medicine commenced at any point along the continuum with the purpose of assisting the individual in moving as far to the right as possible. In 1975 John Travis established his wellness center in California. Dr. D. C. Jarvis, in his book, Folk Medicine ( 1985), predicted that "the doctor of the future will be a teacher as well as a physician whose real job will be assisting people how to learn to be healthy" ( Ardell 1977, p. 17). At Travis's Wellness Resource Center, the goal was exactly that. Those who were ill and in need of medical treatment were sent elsewhere to physicians; clients at the center were well and would go through a detailed program that would make them feel even better. Central to the program was education about stress control, physical fitness, nutrition, and self-responsibility. Travis believed that his clients should be aided in discovering how they were contributing to their difficulties. They were encouraged and taught how to take charge of their lives to achieve healthier lifestyles ( Ardell 1977).
Donald B. Ardell, like Travis, has been called a father of the wellness movement. As a health planner, it was Ardell's desire to make the health care system more efficient. Within the medical system, his roles were educator, researcher, consultant, and administrator. He left his job because he believed that health planning bore no impact on the health care system, which indeed was a sad reality.
Although Halbert Dunn 1961 text High Level Wellness may not have had a dramatic impact at its time of publication, it was quite an eye opener to Ardell who became acquainted with it in 1975. Ardell described Dunn's book as "something akin to being hit with a bolt of 'benevolent' lightening" ( Ardell 1977, p. 5) as he then realized what had been lacking in health planning. In the initial phase of his interest in wellness, Ardell was also influenced by the work of Dr. John Travis. With his book High Level Wellness: An Alternative to Doctors, Drugs, and Disease ( Ardell 1977) and public speaking engagements, Ardell made a major contribution in popularizing wellness. In his 1977 book, he presents many of the themes current in the wellness movement. Two of these ideas are central to today's health promotion programs in the workplace. First, attention to lifestyle and environment, he states, is crucial if one wishes to avoid illness. Second, he notes that medical costs can be reduced substantially if attention is paid to these two factors, which, if neglected, can contribute to unnecessary illness.
Ardell, in his wisdom, spoke about the need for wellness programs in the workplace. He pointed out the staggering amounts that corporations pay for employee medical benefits and suggested, in 1977, that these amounts could double by 1980. Ardell projected, with dismay, that the health of the work force was not likely to improve, nor did he expect it to improve in the future. Rather than spending money on treating disease, he proposed that "big and little businesses could probably increase productivity, lower absenteeism, improve morale and otherwise decrease the extent of illness by promoting wellness at the company's expense" ( Ardell 1977, p. 186).Without fear of contradiction Donald B. Ardell can certainly be named as one of the foremost fathers of the wellness movement in the workplace.
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