I am perpetually entertained by the disconnection between what we do and what we say we do in the chiropractic profession. If I polled chiropractors and asked if they were actively engaged in public health work in their practices, I think it's safe to say that most would say "No" or "Hell, no!"
For the next few paragraphs, I am going to do my best to convince you that the only appropriate answer any chiropractor can give to that question is "Yes," no matter where you are positioned along the philosophical spectrum. Second, I will attempt to show why it is important that we fully comprehend and become engaged in our role as public health workers. Third, I will share how you, personally and painlessly, can be a part of something extremely essential to our profession.
First we must define public health. Herein lies the rub. In chiropractic, our perception of public health is rather narrow (since in chiropractic college our public health courses may have focused on microbes, water sanitation, pasteurization, and immunization!). Several different but acceptable definitions for "public health" can be found in various literature. But what is the true meaning of "public health," this ethereal and rather elusive term?
Public health is simply this:
"Efforts made in a society to protect, promote, and restore health."1
Are most chiropractors attempting to protect, promote, or restore health? The answer, I hope, would be a resounding, "Yes!" I believe
all DCs are doing public health work. If you're engaging in any of the following activities, you are doing public health work:
- finding and correcting vertebral subluxations;
- addressing the thoughts, traumas, and toxins that impact health;
- using chiropractic adjustments to treat back pain only;
- using heat, ice, ultrasound, electrical stimulation, etc., to rehabilitate injuries;
- using diet, exercise and other lifestyle recommendations to promote overall health as a complement to the chiropractic adjustment; and
- doing whatever you think will help your patients, depending on the findings of each clinical encounter.
Our role in public health as outlined above is something our profession should be able to warmly embrace. When was the last time we all joined in a common purpose? I think the disservice we do to our own profession is to immediately forget the chiropractic oath, as soon as we cross the stage at our chiropractic graduations. The oath states in part:
"I will regard and refer to my fellow doctors with honor and dignity, giving credit for their dedication and commitment to the profession."
We should give credit to the chiropractors who say their contribution is to remove subluxations, because at the end of the day, they have restored health. We should give credit to the chiropractors who care for back pain patients, and for those who adjust and rehabilitate patients who have suffered injuries. All of these chiropractors have attempted to protect, promote, and restore health (or helped the body help itself towards health) through chiropractic. I admire the diversity of our profession, and wonder if such a range of strategies is what enables us to get such good clinical results.
I have tried to list a range of ideas I have heard from various chiropractors around the globe. I hope you understand the concept that whatever you do in practice, one of the goals is to impact health (or help facilitate the body's inherent ability to heal itself). I sincerely feel that in spite of what words we use to describe what we think our role is, patients' health improves while under chiropractic care (and their wellness potential may also improve). Therefore, all chiropractors on the planet can hold their heads up proudly and say: "I am making an effort to protect, promote, and restore health through chiropractic. I am therefore contributing to the public health effort."
Now that we are on the same page, the next issue is the importance of fully comprehending chiropractic's contribution to public health. In the academic and clinical worlds, the vast majority of health professionals also use whatever tools their professions possess to help protect, promote, or restore patient health. Psychologists help promote and restore mental health; dentists protect, promote and restore oral health. The chiropractor has many tools that help protect, promote and restore health, however, we haven't been terribly effective in describing our role in health promotion to other health professions (at least not in terms they can understand).
Orthopedists know that only a tiny fraction of the patients that seek their help are surgical candidates. For the majority of patients, their tool belt is empty. They want the patients' health to improve, but aside from pharmacotherapy to manage symptoms, they are tool-less and frustrated. Talk to orthopedists, and they will share their frustration with so many cases, most of them the dreaded "back problem." Can chiropractic care usually help the body when there is a back problem? In most cases, yes! If orthopedists knew that we have tools that could potentially help these patients and carry very little risk (aside from cost), most would be pleased to see their patients improve under chiropractic care, and hence stop frustrating them! Family practice or general medical practitioners go through the same frustration every day with nearly every musculoskeletal complaint that comes their way. Chiropractors must become comfortable about speaking of our profession's contribution to many of the major public health concerns that plague lesser-equipped professions.
Chiropractors only serve from one-tenth to one-fourth of the U.S. population.2-5 Once we care for more of these medically frustrating cases, and other professions better comprehend our role on the health care team, larger percentages of the population will reap the benefits of chiropractic care. In the process, all of you in practice know that our patients' general health also may improve while under chiropractic care. I do not know a single chiropractor that hasn't seen a back pain patient's nonmusculoskeltal health also improve while under care. Our profession has thrived in spite of numerous attempts by others (and sometimes even ourselves) to narrow, control, redefine, or simply eliminate the profession. Our steadfast respect and use of our unique tool (the chiropractic adjustment), combined with phenomenal results in the field, ensures that the chiropractic profession will continue to grow and prosper as we contribute to the protection, promotion and restoration of health, i.e., as we continue to do public health work.
Chiropractic care is powerful indeed, but is poorly understood and often forgotten by other health professionals. Our job is to be vocal, and to communicate in the language of the public's health. We are already there; now we just have to say we are there! An important challenge we face is to increase the public awareness of our role, and to increase the awareness of our role among other health professions and policymakers.
How do we raise awareness of the chiropractic contribution to public health? One way is to be vocal in a very positive way for the chiropractic profession. The way to increase public and professional awareness of chiropractic as an essential element of the health care system is to become active in the American Public Health Association (APHA). The APHA is the second largest health organization in the world (second to the AMA). It has over 55,000 members from virtually all health professions and organizations interested in health. The APHA is a spectacular level playing field on which chiropractic and other health professions can work together for the good of the public's health. The APHA is where health policies are formed; where pressure to change health law builds; where the president of the United States, the surgeon general, and legislators feel the pulse of the health care community. Should not chiropractic be a part of that pulse?
Within the APHA, the Chiropractic Health Care Section is getting a reputation. We are becoming well known as go-getters, hard workers, and heavily involved, highly dedicated doctors. One of our members, Dr. Rand Baird, just received an award from the APHA for recruiting more members than anyone else - ever. How cool is that? It speaks volumes that such an award was received by a chiropractor. The APHA is quite pleased.
There's a great deal of positive interprofessional dialogue at the APHA that is favorable toward chiropractic. The "buzz" now routinely includes chiropractic. When issues in health care come up that might impact chiropractic, or might be appropriate issues for chiropractors to deal with, the Chiropractic Health Care Section is sought out. "If you're not at the table, you won't be served," but the Chiropractic Health Care Section is now often first seated at the table, and we often stay after to help clear the plates! But when you are clearing the table with the surgeon general of the United States, it has its rewards. I have met and spoken to the last two surgeon generals, an opportunity I would never have had were it not for my involvement in the APHA. This past October, a Chiropractic Health Care Section leader, Dr. Mitchell Haas, was chosen to introduce the U.S. Surgeon General Dr. David Satcher to a room of over 1,500 people at APHAs annual meeting in Atlanta! In our short time as a section, we have had our chiropractic members appointed and elected to some of the highest-ranking offices within the APHA - all because we're at the table, and because we are willing to be vocal and contribute actively to the public health dialogue.
So, this is my personal invitation to you, as this year's chairperson of the Chiropractic Health Care Section, to step up and be seated at the table. You would not believe the opportunities in the APHA for our profession, but you need to be there. If you are interested in joining the APHA, or, better yet, becoming an outspoken and hard-working leader within the APHA, email me (preferred) or call me at the number at the end of the article. It would be delightful to see the Chiropractic Health Care Section swell in numbers so great that APHA would have to give us additional votes at the decision-making table! (The numbers of voters on policies at APHA are based on the number of members within the sections.) Nothing would be more gratifying than to have chiropractors join APHA in such droves that we become known as the reason the AMA was reduced to being the second largest health-related organization behind the APHA!
Well, such are the simple dreams, but reachable ones, of a chiropractor who sits at the table. (Sometimes I stand, because I am somewhat short). Who will join me? Who will join and succeed me as a leader at the APHA? The time is now, and the opportunities are endless. I look forward to welcoming you to the table.
I leave you with this thought:
"Health care is vital to some of us some of the time, but public health is vital to all of us, all of the time." - C. Everett Koop,MD, former surgeon general of the United States.
References - Last J. A Dictionary of Epidemiology, 3rd ed. New York: Oxford University Press, 1988.
- Christensen MG, Kerkoff D, Kollasch, MW. Job Analysis of Chiropractic 2000: A Project Report, Survey Analysis, and Summary of the Practice of Chiropractic Within the United States. National Board of Chiropractic Examiners. Greeley, CO, 2000.
- Eisengerg DM, et al. Unconventional medicine in the United States: Prevalence, costs, and patterns of use. N Engl J Med 1993;328:246-252.
- Eisenberg DM, et al. Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey. JAMA 1998;280:1569-1575.
- Hurwitz EL, et al. Use of chiropractic services from 1985-1991 in the United States and Canada. Am J Public Health 1998;88:771-776.
Lisa Killinger,DC
chairperson,
Chiropractic Health Care Section of the American Public Health Association killinger_l@palmer.edu Phone: (563)-884-5854
