Abstract
—John Weeks, Contributing Editor, Special Projects and Collaborations, JACM (johnweeks-integrator.com)
This field has seen the evolution of its name many times over in the past few decades—from folk medicine to alternative and complementary, and then most recently, integrative medicine. Each of these changes has helped position the field closer to and more accurately within the dominant biomedical model—but we are advocating for another revision. The Osher Collaborative for Integrative Medicine has changed its name to the Osher Collaborative for Integrative Health and each of the seven member centers will be changing their names as well. The shift to integrative health from integrative medicine aligns with our mission as a collaborative to promote well-being for all. The term better reflects our work, which provides care beyond the scope of mainstream medicine. Medicine has become a collection of techniques focused on diagnosis and treatment of disease, whereas health speaks to the holistic nature of our work and a focus on wellness.
Defining and naming this field has always been challenging. Early close observers argued that “besides an absence of shared principles, an accurate definition of alternative medicine is further confounded because the boundary demarcating conventional and irregular medicine has always been porous and flexible.” 1 It has been a long journey to integrative health. The unique challenge of this field has been to find an accurate name for a combination of practices and practitioners that was for so long thought of as a catch all for healing practices and traditions that do not fit the prevailing standard model of medicine. In addition, the field of integrative health also must manage the constant shift of practices from unconventional to mainstream categorization due to evolving public acceptance and interest. While our advocacy for yet another change in nomenclature from integrative medicine to integrative health may feel like just another in an endless chain of lexicon shifts that can lose meaning, we argue that this change is essential because the term better reflects (1) the interprofessional nature of the field, (2) the global shift to the promotion of wellness rather than just the treatment of disease, and (3) the Osher Collaborative's core value of health equity.
A long-standing pillar of the field of integrative health is the diversity of practitioners providing integrative services. Massage therapists, acupuncturists, Traditional Chinese Medicine practitioners, health coaches, naturopathic doctors, chiropractors, integrative nurses, dentists, and psychologists have populated the field in addition to, and in many cases before, MDs (medical doctors). Integrative health disrupts the hierarchy of health care, challenging the notion that MDs are the only essential providers. The seven Osher Centers, which represent some of the best in integrative health care, include substantial numbers of non-MD providers, and at some of the centers, non-MD providers are the majority. “Health” is more inclusive of the variety of clinicians at our centers, whereas “medicine” is a narrower name and, for many, conjures an image of biomedically trained practitioners.
Interest in integrative patient-centered care models continually expands in the fields of nursing and dentistry, in addition to medicine. In this regard, our shift from medicine to health is more inclusive of these fields and, therefore, forward-thinking. The evidence supporting integrative nursing approaches in geriatric care, 2 oncology, 3 and pediatrics, 4 for example, is growing. An integrative nursing leader writes that “health care today is a team-based endeavor, and nurses with the skills of integrative nursing are well positioned to be partners in delivering integrated health care.” 5 Dentistry is also continuing to expand to integrative models and the research supporting person-centered care in dentistry is robust. 6 –8 The holistic nature of integrative health is essential to its philosophy, and with the continued expansion of integrative models outside of medicine—the switch to health aligns with the holistic direction the field is going.
As the world has changed in fundamental ways due to the COVID-19 pandemic, many of our relationships with our own health have changed. Before the pandemic, a loose sense of healthy versus unhealthy may have popped up when we had one drink too many or needed to stop at a drive through on a long drive, but the threat was distant and abstract. For many people who had not struggled with chronic illness, this was the first time we had to cope the immediate threat of disease and the risks associated with that. On top of the fear of the illness itself, was the insufficient capacity of our medical systems as ICUs became overcrowded and ran out of supplies. For many, the focus on prevention and wellness came to the forefront. And while effective vaccines are being distributed, it seems the management of this illness may very well be a consistent part of life moving forward and the shift to a focus on staying well, rather than just needing to rely on medicine—is also reflected in our name change. As the numbers of people with pre-existing conditions who perished due to COVID-19 far outnumbered those without pre-existing conditions, 9 we were all challenged to think about our relationship with disease, health, medicine, and safety. It became more essential to remain healthy and prioritize wellness. This name change is not only inclusive of our field, but it is also timely.
As the country is coming to a reckoning with the structural racism that has long permeated our policies and practices—it is especially essential that our centers work to externally reflect our values. It is central to our mission to promote health equity and this evolution in our name continues to align with this mission. By focusing on health rather than medicine—we can “advance health equity, that is, the attainment of the highest level of health for all people.” 10 Communities of color in this country are under constant stress as the result of race-related stressors and the impact on overall health is great. 11 To continue to challenge the issues of health disparities, we must recognize it is far broader than access alone. Changing our name to reflect our commitment to health and not just providing medicine, better aligns with our values and better equips us to have an impact.
While a name change can feel small—it is looking ahead to where the Osher Collaborative strives to be and where we feel the field should go—to be inclusive of interprofessional diversity, to be focused on health and wellness in an increasingly dangerous global landscape, and aligned with the values of health equity.