Yoga and Preventive Health Care

These were comments sent to the Bermuda Health Council about yoga's contribution to preventive health care in our Bermuda community.



Bermuda Health Insurance Report 2010 – Bermuda Health Council
( Comments – As invited)

By Joanne Wohlmuth (August 30, 2010)
Overview: I decided to send my comments on the above mentioned report for a number of reasons. I read glimpses of Dr. Astride-Stirling’s remarks over the recent months in the Royal Gazette, and have been very interested about many of the issues and concerns about public heath care that have been raised. I am keenly interested in health and wellness and social sustainability as it relates to health in our Bermuda community and, operate and co-manage a wellness center (The Yoga Centre) in our Bermuda community, and have done so for the past 16 years. I strongly believe in and advocate wellness as a way forward to improve the overall health and wellbeing of my students (particularly as we age) and feel that in our wider Bermuda community, the only way to improve health and cut cost for rising healthcare effectively is to begin educating community members about the importance of preventive medicine and wellness.

In addition to running a wellness center which operates as a not-for-profit organization, I have been self-employed for the past 10 years as an OD consultant and trainer. Notwithstanding, I continue also to work part-time, which restricts putting my energies into what I really want to do, because I simply cannot afford the health insurance. I work part-time in a charitable organization for a minimal wage, just to cover my health insurance, while I continue to try to make a living, doing my “real” work on the side. At this charitable organization, they have never in the past 6 years been able to give me a raise in pay other than a cost of living wage which I have received only in the past three years. This however, because of the increased cost of health care, has diminished my salary over the years, not increased it!

As I get older I see myself working not for a living, or for enjoyment in what I do, but to pay for continued protection through healthcare insurance. I wish that my situation were unique, and if it were, I probably would not be so keen to offer my comments. But it is not. My voice also echoes the sentiments of many aging persons in Bermuda at the expected end stage of their work careers. Hence I share my comments, add my voice, and advocate, for those do not, cannot, or will not, speak out also. Something has to be done to reverse the tide of rising health insurance costs, for the insured or those who would be insured in our Bermuda community, if we are to remain as a thriving community in which to live!

Wellness and the Bermuda Community
To begin with, in your points # 21 and #22 you state, “The leading causes of death on the island are associated with chronic, non-communicable diseases. Chief among them are circulatory system diseases, which include atherosclerosis, congestive heart failure, hypertension and peripheral vascular disease, among others. Circulatory system diseases were responsible for 47% of all deaths in 2007. Lifestyle factors are poor diet, lack of physical activity, smoking, and high levels of alcohol consumption contribute to the incidence of these conditions.

Circulatory system diseases, along with cancers, diseases of the respiratory system and other chronic non-communicable diseases are anticipated to drive and intensify health system utilization and expenditure over the next decade. The management of chronic diseases requires integrated services from preventive care, to primary care, to hospitalization. This has two implications for Bermuda’s health system. First, it challenges the degree to which the standard hospital benefit package can adequately meet the basic healthcare needs for the population. Second, it requires a financially strong and well functioning health insurance system that treats all strata of the population fairly and equally.”

While I agree with and support your points #21 & #22, I’d like to expound upon the point about ‘preventative medicine’. Insurance companies and the companies/organizations that they serve and health care professionals, need to be encouraged to look at lifestyle management, preventive medicine and wellness as the best way to keep cost down and change the tide of rising health care in our western world. Hence companies that are prepared to invest in educating the community about preventive health care; insurance companies that are willing to partner with health and wellness centers and professionals to keep clients well; insurers who invest in seriously changing the tide in community health, by partnering with organizations like our yoga centre, should be applauded.

It is not good enough for doctors to just write prescriptions and request expensive testing. It is a proven fact that preventive approaches to healthcare that encourage insurance companies and the companies they serve (as well as healthcare professionals) to develop programs and/or liaise with wellness professionals, to educate clients to be more responsible about their health and to make quality health choices and significant lifestyle changes (if possible) before the damage occurs, is the most conscientious way to effectively bring down healthcare costs in the main, by avoiding them in the first place.

Bermuda, as per your report, has a population with 64% of its residents obese or overweight, 14% living with Type 2 ( I’m presuming) diabetes, a community where the leading cost of death is circulatory system diseases, for nearly half of its population. Our community is clearly one that has exorbitant health costs primarily due to poor lifestyle choices, which makes it a whole community issue, not just one for the insurance companies. From an article in John Hopkins Magazine, winter 2009, the writer Rich Shea makes reference to an article by Dr. Bernard Guyer, entitled “The Embarrassment of Riches”, in which he (Guyer) says, “the forces that shape the health of our population are not just medical but social, environmental, economic, political and cultural as well..” Guyer is also quoted , in the Shea article ( The Long View) , saying

“ Most of what goes on around adult chronic disease in health care is contemporary….Treatment, which often includes expensive medicines, caters to the patient after he or she has contracted a disease (this) costs a society a huge amount of money.”

Also on the Preventive Medical Research Institute website, the institute headed by leading cardiologist Dean Ornish - an ardent proponent of a lifestyle approach to health care and a cardiologist known for his work in reversing heart disease - this website states…

“we reported changes in gene expression in the Proceedings of the National Academy of Sciences in May 2008 (Dr. J. Craig Venter was the communicating editor). In that study, we found that changing lifestyle changes genes. After only three months, over 500 genes were beneficially affected—up regulating (“turning on”) disease-preventing genes, and down regulating (“turning off”) genes that promote cancer, heart disease, inflammation, and other illnesses. This is the first time that comprehensive lifestyle changes have been shown to beneficially affect gene expression in men with prostate cancer.”

What I am suggesting here is a greater emphasis on the importance of the management and promotion of wellness and preventive health care as an incentive and a premium way to measure and bring down the cost of health care in Bermuda. If more emphasis were put here, more insurance companies and workplace organizations would be ( I believe) more creative, more innovative and more inclined to partner with organizations like ours for better health care and wellness for their organizations, clients and staff . At present the major scope for insurance companies and workplace organizations when it comes to wellness, is a focus heavily on and geared more toward fitness and massage while more widely used approaches are either ignored or shunned. Preventive approaches like yoga, meditation, deep relaxation, nutrition and healthy relationship building (conflict resolution) as well, are also known to bring about major successes in stress management, healing and wellness, and are proven to be most effective and in lowering the tide of rising health care costs, and should be more seriously considered.

As wellness professionals our center has approached Colonial Insurance and Argus as well as the Cardiac Centre at the hospital about the use of some of these approaches for clients. As highly trained professionals with full accreditation for the work that we do, in particular certification in Dean Ornish’s Cardiac Yoga Training, yoga therapy training; extensive training in breathing exercises, the relaxation response, nutrition, conflict management and various other stress management techniques, we get invited into companies to do Lunch and Learns, but other than that, as professionals, we are being completely underutilized and undervalued in providing assistance to insurance companies and corporations, in this regard!

Notwithstanding, ironically, our centre has been an avenue for improved health and wellness of many persons in the Bermuda community over the past 16 years and has a number of faithful students who come to us, even when they cannot get support for our services through their organizations or insurance claims.

The techniques we offer are integral to most other wellness and preventive health programs abroad, why not here in Bermuda? Just recently a friend returned from Boston General from an operation for breast cancer. Ten days prior to the operation, she was given a Relaxation Response CD to listen to, to minimize the amount of medication she would need and also to accelerate healing. If these practices are honored in other major cities, namely the U.S. to help curb rising health costs, why not here in Bermuda?

I can and will make my plea again to the insurance companies, and to Corporate Bermuda, about the need to consider the services that we have to offer, in their wellness programs if they seriously hope to change the tide of rising health care costs in Bermuda. We would appreciate your support as well.

Healthcare for ageing adults/Self-employment
Secondly, I remember when my husband and I attempted to get house insurance for the home that we own when upgrades were done. I clearly remember that day, as a healthy woman in my early fifties at the time, who exercised regularly, who did not smoke, who was and had been a vegetarian for 25 years and who maintained a well disciplined diet, who drank only wine on occasion and who was an advocate and example of healthy living and had been for the last 30 years, who had never spent time in the hospital other than to deliver two babies, and yet, I was refused this insurance to protect my house! The reason being, my pre-existing health condition (hereditary hypertension, diagnosed at 50) albeit controlled through medication.

I was floored by this company’s response. I said to them, ‘so do you mean if I came in here and was a little younger and had an unhealthy lifestyle, which you as insurers know might lead to a heart attack or stroke or if I were obese and did not exercise or eat right, and if I led a risqué lifestyle, would I than be eligible, if not for the hypertension, albeit controlled? And they, said. “Yes”!’ I was floored again. With this experience in mind, I am happy to know that the Bermuda Health Council is advocating that insurance companies cover pre-existing conditions and that this kind of discrimination cannot happen in insurance companies or corporations when people need it most.

For about one year during the past 10 years I was fully self-employed, however because of the need to have health insurance and knowing that it was not possible to maintain healthcare and grow a business at the same time, I was forced to return to part-time employment to secure my health care protection. I found, realizing that I could not do both, that to maintain consistent health care and grow a business as a self-employed person, trying to get started, is extremely difficult to do in our society. I found it a huge risk, and for a period, like many others who have found themselves in similar positions, I was without protective health care as a self-employed person. Hence, I truly appreciate the consideration to protect self-employed persons in Bermuda, when it comes to health care; appreciating how difficult it can be for the average person in Bermuda who is self-employed, to maintain health insurance. The fact that our management team at the Yoga Centre runs a none-for-profit organization, where we serve the public without payment to ourselves is attributed to the fact that it has never been affordable to do otherwise. This however has an overall effect on our centre’s ability to growth and to remain in operation.

Finally, despite my eagerness to side with your council with your motivating insights and proposals, I still believe that with the infrastructure of Big Business and Insurance Companies, whatever regulations you impose, when all is said and done, it will be the consumer, the customer and/or the patient who will pay and who will be most disadvantaged. So how the Council works out these fine details, it shall be interesting to observe. The last amendment where the patient now pays up front has a huge negative impact on the average person who requires healthcare, such that now (because of lack of funds to pay up front) many members of the community are just not bothering to go to take care of their health needs. This is tragic!

Finally, I believe the report is a valuable and an important contribution for the improvement of public health in Bermuda. However if everyone is to truly benefit from these insights, everyone needs to feel involved, be made to be responsible; and, encouraged to do their share to help lower rising healthcare costs in Bermuda. So I do hope a healthcare/wellness conference will be a future endeavor of the Council, to educate the Bermuda community, and rally them to your cause.

Many thanks for this opportunity to share.

Sincerely,

Joanne Wohlmuth MA, E-RYT -500, Certified Mediator (workplace, family and spiritual institutions)