By Katherine Naylor: Marlboro Graduate MBA in Managing for Sustainability student and Vermont small business owner

From 1940-1980, a study tracked well-being and found that psychological well-being and physical well-being are inextricably linked. The key is to strike a balance among work, love and play; have fun!

Stress and depression are linked to fatal heart attacks.  Poor interpersonal relationships (particularly with spouses) are linked to coronary heart disease

In healthy spousal relationships, when one spouse dies, there is an interesting statistical trend. If the wife dies, there is a 50% chance that the husband will die in the following year. If the husband dies, there is no change in the likelihood that the wife will die within the next year. Why? Because women tend to have more interpersonal relationships, while men tend to rely heavily on their spousal relationship for social well-being

Film clip: Lars and the Real Girl: This video clip demonstrated a number of topics that opened up our session for discussion. One was the respectful, open way the doctor related to Lars (the patient) and how, even though she knew he was delusional, treated him in a compassionate, straight forward way by accepting his delusion as his truth and going along with it. It also demonstrated his brother’s disgust with Lars and how he thought he needed to be “fixed”. The interaction between the doctor and Lars’ brother highlighted the deep seated stereotypes that our culture has about those who suffer from mental illness. It also showed how successful a responsible, caring, inclusive, communicative doctor can be.

In contrast, studies show that on average, a doctor interrupts his or her patient within the first 15 seconds of their visit.

One important part of Vermont’s healthcare reform is to include mental health as a top priority as it links to physical health, or inversely to physical illness. Statistically speaking, one of every five children in the US with mental health issues actually are treated (2000 Surgeon General Report). The top two illnesses in America are mental illness and alcohol and drug abuse, which in many cases are inextricably linked issues. These two along with family stress and violence appeared as “top community concerns” in a study. Furthermore, there is a negative stigma about these kinds of problems that makes them socially unacceptable and increases the likelihood of going untreated out of embarassment, fear, or shame.

In the business world, psychological health is not only necessary, but it is profitable. Absenteeism, accidents, low morale, and other problems in the work place linked to unhealthy people (physically or psychologically) cost companies money. Therefore, employers have an incentive to motivate employees to stay healthy.

One such model is through an Integrated Care healthcare reform. This model of healthcare would actually focus on health, rather than illness. It would reward and provide preventative care plans for people. The healthcare providers would in turn be rewarded by doing their jobs better (measured through the number of healthy people, not the number of sick people). This kind of restructuring would require a payment salary provided to doctors, nurses, and other healthcare professionals in a way that connects specialists as a team that supports individuals’ health and that get paid the same salary, no matter what. This way, if everyone does their job correctly and their patients aren’t coming in as often, they have free time while still making money. Makes sense, right?

Another approach is an incentive program designed by a business to promote healthy employees. This requires changing behavior at a cultural level, which we all know is just about the hardest thing to do. However, it is being done through incentives, team building and support, and promoting a happier, more loyal employee base. This plan design (at Brattleboro Retreat) has a consumer-driven high deductible plan, but preventative care is paid 100%. Additional support is provided through company internal wellness program that earns employees points toward gift certificates. Furthermore, the company has facilities, such as a fitness center, gym, pool, and a number of classes that are available to employees at no cost (though classes have a fee). Other structural planning to promote health includes per diem work opportunities, 3-4 day work weeks, non-traditional hours, a child development center for employees with children, and an employee assistance program.

In my conclusion of the information presented at this session, I found some systematic approaches being used, such as the holistic business initiative, but I also found some rather linear components that I would chose to revise. First, the point system for employees relys on a limited number of indicators of health. One of the categories under which one could earn points was weightloss, which assumes that everyone needs to loose weight and that losing 5 pounds at 200 pounds is worth as much as losing 5 pounds at 115 pounds (both in value of point and in positive health metric). While I don’t necessarily have a great qualitative measurement to offer as an alternative, it seems like a more comprehensive look at “progress” in health may be more effective and more honest.

I also started thinking about systems and non-linear approaches to healthcare reform (which may be a contradiction, based on the linear nature of policy writing). In consideration of supporting the physical and psychological health of Vermonters, it seems like lifestyle may only be part of the picture. The ways we eat and exercise are obviously important factors, but looking at the interpersonal relationships a person has, or even opportunities to develop them is important, particularly in more rural areas. Quality of food, local and organic, not just any piece of fruit or vegetable from the supermarket is also something we need to be more conscious about. The homes and buildings we reside and spend our time in need to be healthy. There are so many aging buildings in Vermont and shoddy construction buildings and vinyl mobile homes that are simply not healthy to live in, either due to off-gassing chemicals, mold, poor ventilation or a combination. However, people living in these types of homes usually can’t afford to retrofit them or move into something more suitable for a living being. Furthermore, many people who don’t work or can’t find work do not have options in what housing they are placed in, which tend to be the worst of these mentioned. So, let’s design an integrated program to address sick-house syndrome while we’re on the track of reforming our healthcare system. And let’s not forget about the ill state of Vermont’s job market, which is also a major contributing factor to poverty, poor health, low levels of education, and the continuation of our currently unsustainable system. I know that efforts are being made in all of these areas, so bringing those involved in the development of improving economic health in Vermont, healthy homes and businesses, and healthy people together into dialogue seems like the systems-based thing to do. So, where do we start?