Whole Person Health: An Approach to Closing Health Gaps
Helene M. Langevin
US National Center for Complementary and Integrative Health

ounting evidence points to concerning health trends worldwide. In the US, provisional data reported by the Centers for Disease Control and Prevention (CDC) show that life expectancy, at 76.1 years, is the lowest it has been since 1996. COVID-19 has taken a high toll, but the pre-existing crises of chronic pain, opioid misuse, and obesity and its related conditions like heart disease, kidney failure, and diabetes fuel the loss of not just years but also quality of life.

This worrisome picture is becoming more common around the world. The global burden of noncommunicable diseases (NCDs) is growing, especially among low- and middle-income countries, accounting for seven out of 10 deaths overall. Most deaths are driven by chronic conditions including cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes. Many of the same factors that fuel poor health outcomes in the United States—like poor diet, sedentary lifestyle, and chronic stress—are demonstrating their corrosive power internationally, and particularly so in vulnerable communities.

It’s time for those of us working across the healthcare ecosystem—from the research community to those on the front lines of providing care and support to individuals—to take a critical look at what we are doing and evaluate what is going well and what needs to improve to get us collectively back onto a positive health trajectory.

One area that illustrates this point is our usage of pharmaceutical drugs. To be sure, medications can be lifesaving and allow individuals with chronic diseases to live longer, fuller lives. However, drugs are increasingly prescribed for prevention, and it is less clear whether prescribing a drug early to prevent the development of a disease is necessarily the best “first line” course of action. A case in point is glucose-lowering agents for prediabetes and lipid-lowering agents for early hyperlipidemia. “Side effects” of medications (such as nausea or muscle aches) are typically viewed as nuisances to be tolerated and a necessary price to pay for correcting the specific abnormality the drug is targeting. However, another side of this story is that artificially pulling on a given metabolic pathway has consequences as the body tries to compensate, sometimes across different organs and systems. This can result in long-term consequences that may not become apparent until someone has taken a drug for many years–for example, insulin resistance in patients taking statins.

Although the aim of preventing complications of diabetes and cardiovascular disease is laudable, all too often these drugs are prescribed without a prior trial of lifestyle interventions, including adequate support for behavior change. Factors contributing to the overreliance on drugs include a tendency to treat each disease as its own separate problem, and failure to recognize that the same lifestyle interventions—diet, physical activity, and stress management—can prevent, and even reverse, if addressed early, a host of interrelated conditions including type 2 diabetes, hypertension, obesity, nonalcoholic fatty liver, chronic kidney disease, and degenerative joint disease. Strikingly, in contrast to drug side effects, the “collateral effects” of lifestyle interventions are uniformly beneficial across multiple systems.

In short, we need, and don’t have, an integrated approach to support the health of the whole person.

Considering whole person health requires recognizing that our body’s different systems are deeply interconnected, like an intricate spider web. When we engage with one part, either harmful or beneficial effects will reverberate across the entirety of the system.

However, conducting research on the whole person is challenging. The National Center for Complementary and Integrative Health (NCCIH) has mapped an ambitious approach for driving research on whole person health in our 2021–2025 strategic plan. This work focuses on building the necessary research infrastructure to support more complex, multifaceted studies and interdisciplinary collaborations.

A number of factors have come together in recent years that will allow us to ask new questions in new ways about whole person health. First, the whole person health concept is increasingly being embraced in the US and internationally. Whether I am speaking with colleagues at the National Institutes of Health (NIH), at the Veterans Health Administration, or at other US federal health agencies or with international research audiences, I hear deep interest in and enthusiasm for embracing whole person health. NCCIH is part of efforts to employ increasingly sophisticated approaches to data analytics via our role in NIH’s Bridge to Artificial Intelligence (Bridge2AI) program, where one of the projects explores the concept of “salutogenesis,” or health restoration, by which we can move from a less healthy to a healthier state. Understanding basic endogenous mechanisms of health restoration is important to determine how best to support it through integrated lifestyle interventions.

These new developments position the research community to explore important questions about the role of nondrug integrated approaches in promoting health across the lifespan. NCCIH’s research has built an essential body of knowledge about psychological, physical, and nutritional interventions. But a deep reservoir of unanswered questions remains. What happens when we combine different interventions? How do we increase the durability of lifestyle modifications, which have known benefits but, too often, fail to “stick”? What are the long-term effects of these interventions on health and healthy aging? And how do we conduct this complex research successfully?

The prospect of bringing together levels of understanding—molecular, cellular, physiological, social, environmental—through the framework of whole person health holds great promise. If we drive rigorous research that sees the whole person, changes in healthcare will follow. We will be better equipped to leverage the right approaches for the right people at the right time. The more we drive research that can empower people to achieve good health with nonpharmacologic interventions, the more we’ll be able to optimize the use and benefits of medications when they are most appropriate, without putting the entire burden of delivering good health outcomes on these tools. The state of health in the US and around the globe is sending a clear signal; it’s time to reframe our understanding of health to embrace a whole person health approach that can help people live longer, better lives.