The National Academies of Science (NAS) report, Achieving Whole Health, a New Approach for Veterans and the Nation1, recently gave the American health system a failing grade because “the country has designed a health system to cure disease and not to promote health.” Their Committee on Transforming Health Care to Create Whole Health calls for a whole healthcare solution that focuses on people-centered care and considers the needs of individuals, their families, and their community throughout their entire lifespan. The Institute for Natural Medicine contends that an example already exists. Naturopathic doctors (NDs) are ready to support whole health care to close the gaps in primary care and other sectors of conventional medicine.
Naturopathic medicine was founded on whole health care; its core values consider an individual’s physical, mental, emotional, genetic, environmental, social, and spiritual health. Naturopathic medicine is, by definition, whole person care.
Whole health is physical, behavioral, spiritual, and socioeconomic well-being as defined by individuals, families, and communities. To achieve this, whole health care is an interprofessional, team-based approach…[that] aligns with a person’s life mission, aspiration, and purpose.”
Achieving Whole Health: A New Approach for Veterans and the Nation, National Academy of Sciences (NAS), 2013.
The COVID-19 pandemic showed how poorly prepared our country is to treat noncommunicable diseases, such as obesity, heart disease, and diabetes. A study in the Journal of the American Heart Association found that 63.5% of COVID-19-related hospitalizations were jointly attributable to diabetes mellitus, obesity, hypertension, and heart failure3. According to the CDC, 94.9% of those hospitalized for COVID infections had at least one underlying health issue, with obesity being the most deadly4.
Medical care in the U.S. is focused on acute care and disease-symptom treatment rather than promoting overall well-being or preventing disease. A whole-health committee set up by the National Academy of Sciences says that addressing chronic lifestyle conditions that plague the nation will require a radical mindset shift. Conventional medicine is currently not equipped to address the social and community health factors that typically operate outside most healthcare systems.
“The country has failed to adequately invest in addressing upstream factors that drive well-being; these known social determinants of health shape our daily lives and influence health more than health care delivery itself. The nation has focused on developing new cures to disease but has neglected to advance the science and systems of how we deliver care, which is essential to ensuring that the right people get the right care at the right time,” the committee wrote1.
Naturopathic Medicine is Whole Person Medicine
Naturopathic medicine was founded on the principles of the social determinants of health. Naturopathic doctors use whole-health care for all their patients. NDs are trained to uncover, evaluate and address all obstacles to healing. It defines the individualized approach they give to every patient.
A recent commentary in Global Advances in Health and Medicine2 points out that “naturopathic medicine is an existing model of whole-health delivery.” Its philosophies and foundational principles are at the apex of traditional and complementary therapies. Naturopathic doctors already serve as primary care physicians in several states. NDs are also trained and are ready to assist in educating other types of primary care physicians and conventional medical education institutions about how to transition to whole-person care.
As is often the case with lifestyle conditions like those seen among the most chronically ill in America, their conditions are not defined as a singular ailment. Naturopathic medicine is ideally suited to address a constellation of symptoms, social and environmental barriers, and emotional health challenges. “Where allopathic medicine most often falls short, naturopathic medicine tends to shine,” says David Katz, MD, MPH, FACPM, in a statement for the report, Naturopathic Physicians as Whole Health Specialists.
To achieve a patient’s goals, an integrative, whole person care model must support the interprofessional collaboration of naturopathic physicians with other healthcare professionals. “Naturopathic physicians working in integrative settings provide an exceptionally well-qualified experience base for fostering high-performance, cost-effective team-based care,” the report concludes.
Naturopathic Medicine is:
- Comprehensive in its approach to whole health, whole person primary care.
- Focused on addressing underlying causes of acute and chronic diseases.
- Dedicated to health promotion, minimally invasive therapies, and reducing healthcare costs.
- Individualized to engage patients and to support health-related lifestyle and behavioral change.
“As medical institutions study solutions to the widening gap in primary care physicians and the importance of whole-person care, naturopathic medicine sits at the intersection of these critical issues,” says Michelle Simon, ND, Ph.D., CEO and president of the Institute for Natural Medicine.
Naturopathic Doctors Are One Solution to Address Gaps in Primary Care
The preventive measures of lifestyle and behavioral medicine, defined within whole-person care, address the root cause of comorbidities that compounded the health catastrophes seen during the pandemic’s peak. Yet most medical doctors do not have adequate training in whole-person care (we outline the differences between an ND and MD, DO here). Lack of training is one barrier; shortage of primary care doctors is another. The Association of American Medical Colleges projects a shortage of 17,800 to 55,2000 primary care doctors in the U.S. by 2035.
“This annual analysis continues to show that our country will face a significant shortage of physicians in the coming years,” said AAMC President and CEO David J. Skorton, MD, in the organization’s annual report. “The gap between the country’s increasing healthcare demands and the supply of doctors to adequately respond has become more evident as we continue to combat the COVID-19 pandemic. The challenge of having enough doctors to serve our communities will get even worse as the nation’s population continues to grow and age.”
One solution that has a proven track record is using naturopathic doctors in primary care settings, particularly in rural areas where shortages of primary care doctors are more prominent. “Naturopathic doctors are trained as primary care, whole health physicians,” says Simon. The INM Primary Care Task Force was established in 2018 to ease the burden of physician shortages in the Pacific Northwest. Washington State is an ideal model for integrating naturopathic medicine into federally qualified health centers (FQHC). Doctors like Logan Rost, ND, have experienced great success addressing chronic conditions for patients in North Central Washington (read more about Dr. Rost here).
Naturopathic physicians have been integrated into a larger team of providers with great success by adding the following practices to the primary care setting, where applicable:
- Healthy diet, movement and exercise, stress management, emotional and spiritual health, toxin exposure management, social and environmental determinants
- Therapeutic diets and nutrition therapy
- Botanical medicines and dietary supplements
- Restorative therapies: hydrotherapy, manual medicine, homeopathy, etc.
- Evidence-based, disease-targeted therapy: therapeutic use of nutrients, vitamins, herbs, and, where state regulations include it in the profession’s scope of practice, pharmaceuticals
- Physical medicine modalities: massage, acupuncture, physical therapy, regenerative injection therapy (trigger point therapy, prolotherapy, platelet therapy, etc.)
- Mind-body techniques: mindfulness meditation, yoga, relaxation modalities, sensory-based therapies, behavioral modification, biofeedback, etc.
Naturopathic Medicine, Whole Health, and the Veterans Administration
The NAS report suggests the creation of a National Center for Whole Health Innovation based on systems created by the Veterans Administration. The VA’s model for whole-health care has changed the healthcare conversation within its ranks from “What’s wrong with you?” to “What matters to you?”
When the VA developed its whole health program, it knew that licensed naturopathic doctors should be included – whole person care has always been the guiding foundation of naturopathic medicine. “Since the inception, naturopathic physicians have been a part of the VA’s team approach to whole person care,” says Dr. Simon.
An American Association of Naturopathic Physicians survey of Veterans found that nearly two-thirds (64%) prefer to see a doctor who prescribes natural therapies before considering drugs or surgery. Nearly three-quarters of veterans (73%) would consider seeing a naturopathic physician if that professional were on staff at a nearby VA facility. Veterans are interested in doctors who emphasize noninvasive, natural therapies and spend time with their patients on individualized whole-person care.
Whole-health care has a dual approach to care: it addresses the “social and structural medical determinants,” which are at the root of most poor health in the U.S. Like naturopathic medicine, whole health care promotes resilience, disease prevention, and restoring health. It also educates patients about their role in changing behaviors and adopting life-long healthy habits to reduce the risk of chronic diseases.
Source: Naturopathic Physicians as Whole Health Specialists
All of the guiding principles of naturopathic medicine correlate to what is defined as whole person care today:
First, Do No Harm
Core to all medical practice is the desire to help the human form and condition. Naturopathic doctors typically approach care by utilizing the most natural, least invasive, and least toxic therapies. If necessary, NDs will refer a patient to another doctor when the patient’s presentation is outside their scope or level of skill.
The Healing Power of Nature
Naturopathic doctors use nature and innate healing as the foundation of human health. Naturopathic doctors recognize and harness the body’s natural ability to heal itself in order to guide patients to wellness and total health.
Identify and Treat the Root Causes
There is a time and place for symptom suppression. However, NDs identify the underlying causes of illness and remove obstacles to cure and heal first and foremost.
Doctor as Teacher
Naturopathic doctors focus on patient health literacy. Naturopathic doctors partner with patients and other practitioners to help them better understand what it takes to be and stay well. Through education and a trust-based relationship, patients and other healthcare providers better understand the steps necessary for better health.
Treat the Whole Person
Naturopathic doctors understand the interconnectedness of the body, the environment, and lifestyle on total health. It is only through this whole-person-based approach that NDs seek to restore balance and health.
Prevention
Naturopathic medicine affirms that it is better to prevent illness and suffering whenever possible. Through their comprehensive practice, NDs combine all six principles to identify potential areas of imbalance and teach patients how to get well and stay well.
Naturopathic Doctors are Trained in the Core Values of Whole Person Care
Few realize that naturopathic doctors who graduate from accredited naturopathic medical schools have the same training as medical doctors, plus hundreds of hours of education in whole-health medicine to address the root causes of chronic lifestyle conditions. Naturopathic medical students participate in four-year, hands-on medical school training plus clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, physical medicine, and counseling.
These practices are not well known in the conventional medical system and are sometimes met with skepticism. Alex H. Krist and Jeannette South-Paul, Co-Chairs of the Committee of Transforming Health Care to Create Whole Health, point out in the NAS report’s preface that it will require a “significant amount of coordination and harmonizing of different systems of care” as other doctors and other types of healthcare providers are integrated into clinical settings under the practice of whole person care. Each brings a new level of knowledge and education about personalized medicine and whole person care.
“While this type of change may seem like a big lift for conventional medicine, the knowledge to bring whole person care to healthcare institutions already exists. There are hard-working integrative and naturopathic physicians working in well-known hospitals, academic institutions, and federally supported clinical settings who can help guide this process,” says Dr. Simon.
Naturopathic physicians who work in integrative settings have proven they provide an exceptionally well-qualified experience base for fostering high-performance, cost-effective, team-based care for whole health medicine. Naturopathic medicine also supports the interprofessional collaboration of naturopathic doctors with other healthcare professionals to teach how to implement whole person care in various clinical, academic, and hospital settings.
As the medical system moves toward whole person care, it will be necessary for other healthcare providers to understand that naturopathic doctors graduate from accredited medical colleges, a fact often misunderstood in conventional medicine.
What is Naturopathy?
Naturopathy is categorized as a discipline of traditional, complementary, and integrative medicine by the World Health Organization and a system of complementary and integrative health (CIH) by the National Center for Complementary and Integrative Health of the National Institutes of Health (NCCIH).
We submit naturopathy is most accurately portrayed as an existing model of whole health delivery, defined by its philosophies and predilection for integrating traditional and complementary therapies within the structure and responsibilities of primary care.1 In the United States, states such as Oregon and Washington, where naturopathic doctors (ND) are licensed and regulated as primary care providers, their scope of practice can include evidence-based diet and lifestyle counseling, mind-body therapies, natural products, joint manipulation, physical therapy, minor surgery, pharmaceuticals, and more.2,3
However, the scope of practice, training, licensure, and professional designations (i.e., naturopathic practitioners (NPs) or naturopaths versus naturopathic doctors) vary by country and state, making the global contribution of naturopathy in healthcare challenging to quantify from a health services perspective.4 Yet, the unifying principles within naturopathy serve as essential frameworks in delivering whole health in primary care—treating the whole person, identifying the root cause of disease, disease prevention, and health promotion.
Given their representation globally, NDs are uniquely positioned to introduce and guide patients through diverse medical modalities, including those considered both “complementary” and “conventional,” in an evidence-based framework, exemplifying a culturally appropriate and holistic model of care.5
‘Naturopath’ is a common term among some complementary and alternative health therapists, which only adds further confusion. Naturopathic doctors, however, have a four-year medical degree from a graduate-level naturopathic medical school, which is accredited by the Council on Naturopathic Medical Education and recognized by the U.S. Department of Education.
- Eight naturopathic medical schools in the U.S. and Canada are accredited by the US Department of Education,
- Each includes a 4-year doctoral program of 4,100 total hours and 1,200 clinical hours;
- Two years of biomedical sciences, two years of clinical sciences, and 700 patient visits are required to graduate;
- A postdoctoral licensing examination is required by the North American Board of Naturopathic Examiners.
Evidence for Integrating Naturopathic Medicine into Whole Person Care
The National Academies of Sciences report shows that people are not getting the right care at the right time. It’s time to integrate all whole person care disciplines and give Americans the care they need.
Naturopathic medicine’s focus on health promotion, disease prevention, and minimally invasive treatments has many positive benefits, including:
- Cost savings for conditions burdening the medical system and insurance companies, including pain, cardiovascular disease, diabetes, and others.
- Primary prevention practices that address root causes of illness to decrease the development and progression of disease and its complications.
- Enhanced effectiveness of conventional medical treatments by minimizing side effects through non-invasive treatments.
- Improved treatment response and decreased recovery time from invasive procedures.
Numerous studies support the effectiveness, cost savings, and patient satisfaction when naturopathic medicine is integrated into conventional medical settings:
- Patient-reported experiences with first-time naturopathic care for type 2 diabetes, Oberg, et al. 2012.
Conclusion: The routine clinical approach used by NDs is consistent with behavior change theory, and clinical strategies found most effective in promoting self-efficacy and improving clinical outcomes.
- The role for naturopathic medicine in hospital-based care, Bernhardt, et al. 2017.
Conclusion: This study of 1,711 acute-care inpatients with an average hospital stay of 11.9 days showed a high degree of patient satisfaction with combined care from naturopathic and academic medicine providers. Patient teams were composed according to specific patient needs and included: general medicine specialists, naturopathic doctors, anesthesiologists, neurologists, orthopedic surgeons, and allied healthcare providers. Integration of naturopathic medicine into acute inpatient care: an approach for patient-centered medicine under diagnosis-related groups.
- Integration of naturopathic medicine into acute inpatient care: an approach for patient-centered medicine under diagnosis-related groups. Romeyke, et al. 2017.
Conclusion: A majority of patients rated integration of naturopathic practice into hospital settings positively. Integrating naturopathy may be effective for multi-morbid patients and patient-centered care can improve staff satisfaction levels. Integrating naturopathy into clinical practice “can serve as a Unique Selling Proposition.” Integration of naturopathic medicine into acute inpatient care: An approach for patient-centered medicine under diagnosis-related groups.
- A naturopathic approach to the prevention of cardiovascular disease: cost-effectiveness analysis of a pragmatic multi-worksite randomized clinical trial. Herman, et al. 2014.
Conclusion: This multi-worksite-based study showed that a naturopathic approach to CVD primary prevention significantly reduced CVD risk over usual care plus biometric screening, and reduced costs to society ($1,138) and employers ($1,187).
- Group-based naturopathic education for primary prevention of noncommunicable disease in families and children: a feasibility study. Solomonian, et al. 2019.
Conclusion: Group-based family education in primary prevention delivered by naturopathic physicians may be a feasible education method for caregivers. Healthy behaviors between parents and children were correlated. A majority of families were satisfied with the program and showed ongoing benefits at six weeks+ after completion.
- Naturopathic medicine for the prevention of cardiovascular disease: a randomized clinical trial. Seely, et al. 2013.
Conclusion: For each quality-adjusted life years (QALY) saved, a lifestyle modification program costs $8,800 while metformin therapy costs $29,000. Additionally, the lifestyle modification program was shown to be cost-effective in all adults, while metformin was not cost-effective after age 65.
We’ve learned through great hardship that whole health is needed to restore the health of America. “Whole health is an approach that holds great potential for addressing major challenges in health care workforce well-being that have only intensified in recent years,” said Victor J. Dzau, president of the National Academy of Medicine, in a press statement. “As the report says, shifting to a whole health approach would put a renewed focus on professionally diverse teams that work together to provide integrated care — improving efficiency, mitigating burnout, and reducing strain on our health care workers.”
As this country moves toward whole health, it will require a radical transformation to maintain high-quality medicine while embracing a patient’s individual health values, goals, and priorities. A whole person model of care, by definition, encompasses all aspects of medical care and takes into account the entire person, their family, and their community. This is a sharp contrast to current models of conventional medicine, particularly in primary care. Naturopathic doctors are ready to play a role in this exciting time of transformation.
To find a naturopathic doctor who practices whole-person medicine, visit our Find a Natural Doctor directory.
Sources:
- Achieving Whole Health, A New Approach for Veterans and the Nation, National Academies, Science Engineering Medicine. Feb. 2023. https://nap.nationalacademies.org/read/26854/chapter/1
- Sadowski, A., Garofalo, L., Welsh, A., & Bradley, R. (2022). Naturopathic Doctors: An Underutilized Resource of Whole Health Delivery in Primary Care. Global advances in health and medicine, 11, 2164957X221079787. doi:https://doi.org/10.1177/2164957X221079787
- O’Hearn M, Liu J, Cudhea F, Micha R, Mozaffarian D. Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis [published correction appears in J Am Heart Assoc. 2021 Apr 6;10(7):e020858]. J Am Heart Assoc. 2021;10(5):e019259. doi:https://doi.org/10.1161/JAHA.120.019259
- Kompaniyets L.Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized With COVID-19, March 2020–March 2021. Preventing Chronic Disease. 2021;18. doi:https://doi.org/10.5888/pcd18.210123
