Promoting Health and Wellness
Introduction[edit | edit source]
According to WHO health is defined as "a state of complete physical, mental and social well-being and not merely the presence of disease or infirmity." It is a valuable resource that allows people to lead individually, socially, and economically productive lives, providing them the freedom to work, learn and engage actively in family and community life. A wide range of factors affect the health status like personal, economical, social, and environmental. Some of the factors can be controlled while others cannot.
Various reasons have been cited for causing diseases in the medical history from miasma to the germs, including the contributing factors like poverty, lack of education, poor living conditions, etc. Henry E. Sigerist, the great medical historian in 1945 coined the term Health Promotion and defined the function of medicine as 1. promotion of health, 2. prevention of illness, 3.restoration of the sick and 4. rehabilitation. He stated health was promoted by providing a decent standard of living, good labor conditions, education, physical culture, means of rest and recreation and required the co-ordinated efforts of statesmen, labor, industry, educators and physicians. The prerequisites for health are "peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity." Health promotion is the health sector's responsibility and goes beyond healthy lifestyles to well-being. 
Health Promotion[edit | edit source]
The issue-based approach works best with settings-based designs to address priority health problems by considering the complex health determinants such as behaviors, cultural beliefs, practices, etc. that operate in the places people live and work. It helps to facilitate the integration of health promotion actions into the social activities considering existing local situations and can be implemented in schools, workplaces, markets, residential areas.
The conceptual approach looks at the need of the whole population and targets specific interventions to address them comprehensively:
- Healthy population: promoting a healthy lifestyle, preventing risk factors (i.e., primordial prevention are measures that inhibit the emergence and establishment of environmental, economic, social, and behavioral conditions, cultural patterns of living known to increase the risk of disease), and prevention of disorders and health problems.
- Population with risk factors: health promotion, screening, action on risk factors, and maintaining healthy lifestyle.
- Population with symptoms: early detection, treatment, maintaining healthy lifestyle, disability limitation and rehabilitation.
- Population with known disease or disorder: management of disease, maintaining a healthy lifestyle and disability limitation and rehabilitation.
Wellness[edit | edit source]
Wellness is a holistic integration of physical, mental, and spiritual well-being, fueling the body, engaging the mind, and nurturing the spirit. It has 8 mutually interdependent dimensions: physical, intellectual, emotional, social, spiritual, vocational, financial, and environmental. It is important to pay attention to all these dimensions, as neglect of any one with time will adversely affect the others, and ultimately one’s health, well-being, and quality of life. These dimensions do not, however, have to be equally balanced. According to literature, wellness is positive, or salutogenic (health-causing); multidimensional and interactive (i.e., the dimensions of wellness influence each other), and subjective (based on perceptions).
Health Promotion in Communicable and Non-communicable Diseases[edit | edit source]
In current scenarios, with the new diseases emerging, unfinished agenda of infectious diseases, and the unprecedented rise of noncommunicable chronic diseases promoting health has become essential.
Communicable Diseases[edit | edit source]
Despite the focus on health rather than a disease, health promotion is associated with disease prevention. Though it is focussed mainly on non-communicable diseases (NCDs), primary emphasis and resource commitment are on infectious diseases.
Noncommunicable Diseases[edit | edit source]
Emergence of Noncommunicable Diseases (NCD) has contributed to global disease burden and mortality. NCDs kill 41 million people each year, equivalent to 71% of all deaths globally with more than 15 million people per year dying from a NCD between the ages of 30 and 69 years with 85% of these "premature" deaths occur in low- and middle-income countries. Cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes are the most common types of NCDs.
NCDs are preventable by effective and feasible public health interventions by tackling major modifiable risk factors - tobacco use, improper diet, physical inactivity, and harmful use of alcohol. 80% of heart diseases and stroke, 80% of diabetes and 40% of cancers can be prevented by eliminating common risk factors, namely poor diet, physical inactivity and smoking. The key intervention in the control of NCDs is by promoting health which would help people to change their lifestyle and to move toward a state of optimal health.
Role of Physiotherapist in Health Promotion and Wellness[edit | edit source]
Although physical therapists are experts in rehabilitation and habilitation, they play a key role in promoting fitness and wellness by encouraging active living, providing early diagnosis of disease, prescribing targeted activity interventions to improve fitness and participation, and helping individuals overcome personal and environmental barriers to lead an active lifestyle. 
Physiotherapists use nonpharmacological & noninvasive interventions such as providing client and patient education and with their educational background in pathology/pathophysiology, and expert knowledge, skills, and behaviors in exercise, fitness, and wellness help in delivering health-focused care strategies known to be effective in preventing, reversing, and managing many chronic NCDs. The magnitude of time spent over extended episodes of care and close and trustful relationships with patients provides an optimal opportunity to promote wellness and provide education.
Role of the physiotherapists may include education, direct intervention, research, advocacy, and collaborative consultation. These roles are essential to the profession’s vision of transforming society by optimizing movement to improve the human experience. You can read more about it here: Role of physiotherapists in prevention, wellness, fitness, health promotion and management of disease and disability
Five important physical behaviors physiotherapists tackle are
- physical activity,
- nutrition and weight management,
- smoking cessation,
- Sleep Management and
- stress management
Integrating Health Promotion and Wellness in Physical Therapist Practice[edit | edit source]
Physical therapists should be skilled in identifying and instructing their patients in the basic principles of health promotion, including personal hygiene, skincare, dental hygiene, sanitation, tobacco avoidance or cessation, immunizations, avoidance of infectious and contagious diseases, diet, rest, exercise, and weight control. 
To educate patients, physical therapists need knowledge of injury and disease epidemiology, risk factors, and factors influencing safety and injury prevention. Physical therapists can encourage their patients to stop smoking, adopt positive nutrition habits, manage weight, engage in regular physical activity, obtain adequate sleep quantity and quality, and reduce stress
Health and wellness influence each other. An individual can be healthy yet ill, such as exercising compulsively, neglecting relationships, spiritual endeavors, and intellectual pursuits. The opposite also is possible- a person can be well yet diseased, as many patients with chronic disease and disability live productive, fulfilled lives. The important take-home message for physical therapists and other health care providers is that both health and wellness are not just confined to physical health, and efforts that focus primarily on physical health (e.g., physical activity, weight management, nutrition), although necessary, fail to recognize the influence of the other dimensions to overall well-being.
Physiotherapists should recognize the influence of emotions, social support, spirituality, and other factors on the patients to create more individualized and appropriate treatment plans to improve overall health and wellness.  Understanding what motivates the patient or client, what strengths they have in the dimensions of wellness, and what is essential to them provides the physical therapist with valuable additional information to inform a treatment program.
Understanding and recognizing wellness is critical for patients and clients who are asymptomatic as they are typically not motivated to engage in healthy behaviors to improve their health; however, they can be motivated to improve their wellness. Understanding and assessment of a patient's or client's wellness enables the physical therapist to guide the patient or client to make connections between healthy behaviors and values or perceptions (eg, wellness) that they hold, which can be a strong motivator for adopting healthy behaviors.
Barriers[edit | edit source]
The most common barriers:
- lack of interest or awareness of the patient or client, the public, and other health care providers that physical therapists provide these services
- lack of education or knowledge
- lack of reimbursement
- lack of resources.
Additional barriers include limited counseling skills, lack of self-efficacy, the focus on secondary and tertiary prevention by physical therapists, and the perception that the physical therapy work environment is not suitable for health promotion.
Resources[edit | edit source]
References[edit | edit source]
- Community Rehabilitation Guidelines – Health.World Health Organisation. Rehabilitation
- Kumar S, Preetha GS. Health promotion: an effective tool for global health. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine. 2012 Jan;37(1):5.
- The 1st International Conference on Health Promotion, Ottawa, 1986Accessed from https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference on 07/12/21
- Stoewen DL. Dimensions of wellness: Change your habits, change your life. The Canadian veterinary journal. 2017 Aug;58(8):861.
- McQueen DV. Health promotion applied to infectious diseases. Global health promotion. 2015 Jun;22(2):3-4.
- Noncommunicable Diseases. WHO. Accessed fromhttps://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases#:~:text=Key+facts,%2D+and+middle%2Dincome+countries. on 21.12.21
- Quinn L, Morgan D. From disease to health: physical therapy health promotion practices for secondary prevention in adult and pediatric neurologic populations. Journal of neurologic physical therapy: JNPT. 2017 Jul;41(Suppl 3 IV STEP Spec Iss):S46.
- Lein Jr DH, Clark D, Graham C, Perez P, Morris D. A model to integrate health promotion and wellness in physical therapist practice: development and validation. Physical therapy. 2017 Dec 1;97(12):1169-81.
- Hansen A, McGurran-Hanson G, LeDuc K, Von Arb H. The Role of the Physical Therapist in Health Promotion as Perceived by Patients with Neurological Pathologies: A Descriptive Study.
- Bezner JR. Promoting health and wellness: implications for physical therapist practice. Physical Therapy. 2015 Oct 1;95(10):1433-44.