The Multiple Dimensions of Wellness with Dr. Marc Cohen 01086 Start Date: April 14, 2011 End Date: April 14, 2011 Wellness is a multidimensional concept that is still evolving. The multiple dimensions of wellness are evident in the convergence of existing industries and disciplines. The wellness industry has emerged as a trillion dollar melting pot for a whole host of products and services that encourage enhanced health and wellbeing. Rather than merely selling products, wellness industries ultimately involve raising consciousness and thus must address issues of environmental sustainability, ecological design, social responsibility, corporate ethics, health and spirituality. As an academic discipline, wellness represents an intersection of many disciplines including; the biological, health and physical sciences, engineering, business and design. This presentation will provide the background behind the development of Wellness as a new academic discipline and discuss future directions. See recorded live webinar archive at: http://HealthPromotionLIVE.com

1. Wellness at RMIT
Pioneering a New Academic Discipline
Prof Marc Cohen
MBBS(Hons), PhD(TCM), PhD(Elec Eng), B.MedSc(Hons),
FAMAS, FICAE, Dip Ac
Program Leader, Master of Wellness
Foundation Professor of Complementary Medicine,
RMIT University

3. $ Intensive
care
$ Acute care
$ General care
$ Wellness Activities
A stable health system

4. $ Intensive care
Acute care
$
$ General care
Wellness
$
Current health system

5. It’s going to fall over
$ Intensive care
Acute care
$
$ General care
Wellness
$
Current health system

6. All is not well
with the world

7. All is not well
with the world
Pan Books, London (1972).

8. • http://dieoff.org/page25.htm

9. Climate Change
“Climate change represents the
greatest and widest-ranging market
failure ever seen”
“Business as usual is not an option”
A 1% pa investment will prevent a
20% decline in global GDP

10. Toxic Pollution
• 70,000 toxic chemicals are now in
commercial use and around 1,000 new
chemicals enter the market every year
• POPs are found everywhere on the planet
-in our food, soil, air and water.
• Combinations of toxins may combine to
have greater effects than single toxins
• Wildlife and humans around the world
carry POPs in their bodies at or near levels
that can cause injury.
http://www.worldwildlife.org/toxics/basic.cfm

11. Radioactive waste
• High level waste may be
radioactive for many millions
of years and increases by about
12,000 tons/yr
•A number of incidents have
already occurred where
radioactive material was
disposed of improperly,
shielding during transport was
defective, or when it was
simply abandoned or even
stolen from a waste store
www.marathonresources.com.au/nuclearwaste.php
www.greenpeace.org.uk/media/press-releases/greenpeaces-response-
to-corwm
www.iaea.org/Publications/Magazines/Bulletin/Bull413/article1.pdf

12. Toxic bodies
A 1995 study found breastfed
infants in Victoria were
regularly exposed to DDT and
other pesticides at levels greater
than the Acceptable Daily
Intake (ADI) set for adults
[1] Quinsey PM, et al. Food Chem Toxic 1995;33(1):49-56
© Prof Marc Cohen

13. Wealth Inequality
• The richest 2% own more than
50% of global wealth.
• The poorest 50% of adults own
barely 1%
• Wealth inequality for the
world is estimated to be as if one
person in a group of ten takes
99% of the total pie and the other
nine share the remaining 1%.
http://qazse.files.wordpress.com/2006/12/starving-hand-2.jpg
The World Distribution of Household Wealth
World Institute for Development Economics Research of the
United Nations University Kevin Carter 1994 Pulitzer Prize for photography

14. Obesity Epidemic
• Globally, there are more than 1
billion overweight adults
• In the US the number of
overweight children has doubled
and overweight adolescents has
trebled since 1980.
• Obesity and overweight pose a
major risk for chronic diseases,
including type 2 diabetes,
cardiovascular disease,
hypertension and stroke, and
certain cancers.
www.stuffedandstarved.org
http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/

15. World hunger
• The WHO estimates that 1/3 of
the world is well-fed, 1/3 is
under-fed 1/3 is starving.
• 3 billion people in the world
today struggle to survive on
US$2/day.
• Every 3.6 seconds someone dies
of hunger
Kevin Carter 1994 Pulitzer Prize for photography
http://library.thinkquest.org/C002291/high/present/stats.htm

16. Rampant Consumerism
Consumers have access to a
seemingly unlimited choice yet are
disconnected from the products and
services they purchase.
Depression and insomnia are at
epidemic proportions
Unchecked and unconscious
consumption is at the root of many
world problems

17. Chronic Disease
Of the 58 million deaths in the
world in 2005, 35 million (60%)
will be caused by chronic diseases
such as heart disease, stroke,
cancer, chronic respiratory diseases
and diabetes.
The main modifiable risk factors for
these diseases are lifestyle related
and include unhealthy diet, physical
inactivity and tobacco use.

18. What is wellness?
• The constant, conscious pursuit of living life to its fullest
potential
• A state of high consciousness where you can be fully present in
the moment and where actions flow naturally and authentically
from the ‘deep inner well of your being’
• The state where you look, feel, perform and stay ‘well’ .
• Wellness enable you to experience the greatest fulfillment and
enjoyment from life and achieve the greatest longevity.

19. What is wellness?
Wellness is a holistic and therefore has multiple dimensions
including:
- Physical - Psychological
- Sexual - Emotional
- Social - Cultural
- Spiritual - Educational
- Occupational - Financial
- Environmental - Ethical
- Political - Existential

20. The Global Wellness Industry Cluster
www.globalspasummit.org

21. Ill health Average health Enhanced health

22. PERFECT HEALTH
Blissors BLISS
WELLNESS
ENHANCED
HEALTH
Complementary
Flexibility of response Medicine
AVERAGE
HEALTH
Western
ILL Medicine
HEALTH
Stressors ILLNESS
© Prof Marc Cohen

23. Basic Philosophical Concepts of TCM
Tao ∞ Experience
Flow
Chi
Transformation
5 elements
Balance
Yin Yang
Evolution/Entropy
Bu/Xie © Prof Marc Cohen

24. Experience
Bliss
∞
Entropy bandwidth
Flow
Transformation
Balance
Negentropy Entropy
gradient ΔS > 0
gradient
© Prof Marc Cohen
ΔS = 0

25. Wellness and entropy
Wellness is a state of minimal entropy production
Anabolism Catabolism
Consumption Creation
Challenges Capacity
Being Doing

26. Wellness Activities (Blissors)
• Stress management
• Exercise
• Nutrition
• Social / Spiritual interaction
• Education

27. The future of healthcare
“There is growing evidence that the
current health systems of nations around
the world will be unsustainable if
unchanged over the next 15 years.”
“Consumers will be play a much larger
role in healthcare”
“Preventive care and disease
management programs have untapped
potential to enhance health status and
reduce costs.”

28. Most people in the west die of a
broken heart
© Prof Marc Cohen

29. Coronary Artery Disease
Normal Thickened Almost
open scarred and complete
artery narrowed blockage

30. Which therapy would you choose?
(Treatment 1) (Treatment 2)
• 8% ↓ blockage • 28% ↑ blockage
• 91% ↓ pain • 186% ↑ pain
• 50% ↓ in hospitalisations & deaths
• Safer & reduces other diseases
• cost $400 • cost $40 000

31. Intensive lifestyle change
• Low fat vegetarian diet
• Moderate exercise
• Stress management training
• Group support
Ornish, D. et al. (1998) JAMA, 280(23): 2001-7

32. In the current health system
it is considered CONSERVATIVE to;
• strip a vein from the leg
• open the chest
• place the vein across a blocked artery
• repeat the procedure every 10 years
it is considered RADICAL to;
• relax
• exercise
• eat good food
• share your feelings

33. LOHAS
LOHAS
Lifestyles
Of
Health
And
Sustainability
In 2006 LOHAS consumers
spent $300 billion, representing
approximately 30% of the USA
consumer market

34. Public are increasingly aware of:
• Prevention of disease/ageing
• Optimising health/performance
• Deficiencies in conventional medicine
• The need to invest in wellness

35. General dietary recommendations
• Seasonal
• Locally produced
• Organic
• Whole foods

36. ‘Conshumanism’
“Conscious and humane consumption”
“Consumption with maximal awareness, efficiency and
enjoyment and minimal pain, energy, waste and pollution”

37. ‘Conshumanism’
“Conscious and humane consumption”
?
When consuming ask :
• What is in it?
• Who made it?
• Where is it from?
• How did it get here?
• Who benefits from the sale?
• What use is it - is it worth it?
• What is its lifecycle and embodied energy?
• What is its environmental & social impact?
• What are the alternatives – do I really need it?

38. sand
and heaven in a wild flower
Hold infinity in the palm of your
hand
and eternity in an hour
-William
Blake
© Prof Marc Cohen

39. Flow
"a joyous, self-forgetful involvement through
concentration, which in turn is made possible by
a discipline of the body".
-Mihalyi Csikszentmihalyi
© Prof Marc Cohen

40. Arousal Flow
Anxiety
CHALLENGES
Worry Control
Apathy Boredom Relaxation
SKILLS © Prof Marc Cohen

41. New Vocations
• Wellness coach
• Workplace wellness director
• Positive psychologist
• Spa practitioner
• Permaculturalist
© Prof Marc Cohen

42. Professional Issues
• Confidentiality • Education
• Ethical conduct • Continuing Education
• Adverse event reporting • Evidence base
• Complaints handling • Research strategy
• Continuity of care • Professional indemnity
• Contact management • Scope of practice
• Privacy and e-Records • Conflict of interest
• Billing and 3rd party payers • Code of practice
• Referral base • Renumeration levels
© Prof Marc Cohen

43. Presenteeism vs Being present

44. Towards a global health service
No-one wants to go to a hospital but
everyone wants to go to a good hotel
© Prof Marc Cohen

45. Wellness Research ?

46. Sustainable ‘barefoot’ luxury
Six senses resort Hua Hin

47. Natural swimming pools

48. Wellness Design
Earthship biotecture
Permaculture
Living water flowforms

49. Connection with nature
“ access to nature plays a
vital role in human
health, wellbeing, and
development that has not
been fully recognised .”
“ . . . the positive
effects on human health,
particularly in urban
environments, cannot be
over-stated.”
Healthy Parks Healthy People; A review of relevant literature. Maller & Townsend et al 2008

50. Connection with animals
Contact with companion animals
has multiple positive physiological
and psychological effects on human
health including:
– decreasing blood pressure, heart
rate, and cholesterol;
– reducing anxiety and stress and
providing protection against
stress-related diseases;
– provision of companionship and
kinship;
– and the opportunity to nurture.
All of these factors improve quality
of life and enhance health and
wellbeing.
Healthy Parks Healthy People; A review of relevant literature. Maller & Townsend et al 2008

51. If you don’t measure . . . you can’t manage
If you don’t state . . . you can’t communicate
www.iso.org/iso/en/networking/pr/cartoons/pages/measurement.html © Prof Marc Cohen

52. Australian Unity Wellbeing
index
• Subjective measure of
wellbeing
• 19 national surveys since
2001
• Concept of wellbeing
homeostatic set-point
http://acqol.deakin.edu.au/index_wellbeing

53. SWB across the lifespan
80
77.9
78 78.3
77.1
76 76.3
74.7 74.2 74.4 74.3 74.0 75.7
73.8
74 Adult normative range
Strength 73.3
of 72
satisfaction
70
69.4
68
66
64
12&13 14&15 16 17&18 19-25 26-35 36-45 46-55 56-65 66-75 76+
Age group
Dr Adrian Tomyn RMIT University

54. Quality-Adjusted Life Years (QALYs)
• Quality of life is both objective and subjective.
• Objective domains are measured through culturally relevant
indices of objective well-being
• Subjective domains are measured through questions of
satisfaction
• QALY equal 1 for each year of full-health life, less than 1 for
various degrees of illness or disability
• Cost-effectiveness of treatments can be assessed by the cost per
QALY
© Prof Marc Cohen

55. Disability-adjusted life years (DALYs)
Measures of burden of disease
DALY = Years of Life Lost + Years Lived with Disability
1990 WHO report indicated that
5 of the 10 leading causes of disability were psychiatric conditions
which account for 28% of all years lived with disability, but only
1.4% of all deaths and 1.1% of years lost.
Thus, psychiatric disorders, while generally not seen as a major
epidemiological problem, are shown by consideration of disability
years to have a huge impact on populations.
© Prof Marc Cohen

56. BankWest Quality of Life Assessment
based on:
• Home ownership
• Detached housing
• Employment
• Income Levels
• Broadband Internet Access
• Proportion of Empty Homes in an area
• Volunteering Rates
• School enrolments for sixteen year olds
• Proportion of the Population in Good Health
• Property related crime rates

57. Triple Bottom Line Reporting
• John Elkington, who coined the phrase in 1994, has
defined the TBL approach as:
“At its broadest, the term is used to capture the whole
set of values, issues and processes that companies
must address in order to minimise any harm resulting
from their activities and to create economic, social
and environmental value. This involves being clear
about the company’s purpose and taking into
consideration the needs of all the company’s
stakeholders.”
© Prof Marc Cohen

58. Happy Planet Index
www.neweconomics.org

59. Wellness Measures
Wellness includes
• Subjective wellbeing/happiness
• Physiological status - HRA
• Social capital /connectedness
• Ecological footprint
• Security and socioeconomic status

60. Wellness Footprint
“Develop a Wellness
Footprint to evaluate
measure and resource
services . . . and drive a
prevention agenda.”

61. Research Questions
• How do we measure wellness? What is a “Wellness
Footprint”
• How can different measures be used to assess levels
of disease, disability and performance?
• What interventions or policies are most likely to
maximise wellness for individuals, businesses and
communities?

62. Want to learn more?
www.rmit.edu.au/wellness

63. Includes courses on:
Want to learn more?
•Leadership & Management
•Global Business Context
•Corporate Wellness
•Wellness Coaching
•Lifestyle Management
•Positive Psychology
•Mindbody Wellness
•Aromatherapy
•Herbs & Supplements
•Food as Medicine
•Energy Medicine
www.rmit.edu.au/wellness Cross credits available for UC Irvine
Spa Management Course

64. Pessimism and Optimism
• Pessimists -
– GOOD EVENT - external, temporary, specific, (Them, Then, That)
– BAD EVENT - personal, permanent, pervasive, (Me, Always, Everything)
• Optimists -
– BAD EVENT - Then, That, Them
– GOOD EVENT - Always, Me, Everything