The importance of whole health in family medicine.
By Jenna Hughes
When it comes to a patient’s health, clinical care is only one piece of the puzzle.
Indeed, only 16% of health outcomes are attributed to clinical care, according to the American Academy of Family Physicians (AAFP). Nearly 34% of all health outcomes result from patients’ health behaviors outside of clinical settings, and 47% are attributed to patients’ socioeconomic factors such as where people live, work and play.
To fully support patients, primary care must extend beyond the clinical space to address broader health and lifestyle needs. A significant contributing factor to patients’ health outcomes are the behaviors, lifestyle, and choices they make on their own outside of healthcare facilities. Thus, healthcare providers must focus on addressing the remaining 84% of patients’ lifestyle outside of the physician’s office.
Family and primary care physicians play a critical role in guiding patients toward better health outcomes by addressing underlying behavioral and lifestyle factors that contribute to overall well-being.
The active role of the patient in their own healthcare and well-being, known as Whole Health Care, includes the social and structural determinants at the root of poor health, focusing on the priorities and goals of people and communities, centering on promoting resilience, preventing disease and restoring whole-person health, according to AAFP.
“Whole Health is about seeing the person behind the patient,” said Steve Furr, MD, FAAFP, Board Chair of the American Academy of Family Physicians. “It’s a framework that focuses not just on treating disease, but the underlying causes, their entire health history and what really matters most to the patients.”
A Whole Health approach encourages moving beyond symptom management to promote long term wellness.
“By addressing physical, emotional, social and behavioral health together, Whole Health Care shifts care from a reactive model to a proactive, patient-centered approach.”
Elements of Whole Health Care
The practice of Whole Health Care goes beyond in-person, clinical healthcare; rooted in patients having community support and a healing environment, a key element to improving overall health outcomes.
Whole Health Care employs both spiritual and mental dimensions to understand patient behavior and what matters to an individual, enabling patients to take an active role in maintaining their personal health. According to AAFP, when physicians approach care from a patient-centered perspective, patient experiences and reported outcomes are improved, patients have increased access to care, healthcare expenditures are lower, and patients see improvement for specific conditions such as chronic pain, mental health, traumatic brain injury and aging.
The Whole Health Care model consists of five elements:
- People-centered care
- Comprehensive and holistic care
- Upstream focused care
- Equitable and accountable care
- Team well-being
A people-centered care approach focuses on seeing a patient as a whole person – not just their symptoms or illness. Focusing on the individual considers a person’s life experiences and overall situation and relies on long-term, relationship-based care to build patient and community trust.
Comprehensive and holistic care refers to addressing an individual’s health, with physicians working as a clinical team to find and treat the root causes of illness and bringing different health care providers together as a team to provide well-rounded care. Comprehensive care is what care is provided and includes regular medical treatments, but it assesses important factors like lifestyle, social needs and education. Holistic care describes how care is provided and focuses on caring for the whole person, their family and the community.
When a family physician builds a strong, trusted relationship with a patient, it serves to support other important factors that affect health and well-being, such as behavior, social, structural, economic and environmental factors, according to AAFP.
Physicians that are able connect and work closely with other specialists and community resources have a better chance of improving significant health factors that affect individuals and communities.
Improving the social factors affecting health ensures that everyone has fair and accessible health care and is a key aspect of health equity, according to AAFP.
AAFP’s Health in All Policies, which addresses policy decisions made at the federal, state, and local levels directly affect community health by influencing the social and economic factors that drive the social determinants of health improve population health, promote sustainability and advance health equity. Physicians can advocate for environmental, policy and systemic changes in the communities where they live and work and promote equity and accountability for all.
Finally, team well-being is a foundational element of any whole health and lifestyle medicine approach, according to AAFP, with benefits for the interprofessional team and the patients they are providing care to by reducing burnout and promoting workplace-wide wellness.
Lifestyle medicine principles
Whole Health Care aligns closely with Lifestyle Medicine, an evidence-based field that leverages behavior-based interventions (nutrition, physical activity, sleep, etc.) to prevent, treat, and reverse chronic disease.
Implementing Lifestyle Medicine principles in primary care settings can provide a solid foundation for incorporating whole health approaches to patient care, according to AAFP.
The pillars of lifestyle medicine work together with whole health approaches to support physicians looking to complement treatment-based care and emphasize behavioral and lifestyle factors that improve whole health outcomes.
Family physicians, according to AAFP, are uniquely positioned to integrate whole health and lifestyle medicine into their routine care.
“When care teams understand the full context of a patient’s life – including social drivers of health like housing, food access, and emotional well-being – they can tailor interventions that are more effective, sustainable, and aligned with each person’s unique circumstances,” said Dr. Furr. “Family physicians are well positioned to incorporate these factors into care plans.”
The power of primary care
Patients are best served when their primary care needs are addressed by a physician-led, integrated care team and feature a trusted relationship with their physicians.
Trusted relationships and open dialogue with patients allow family physicians to align their care with the patient’s values and treatment goals, according to AAFP. Family physicians can also connect patients with other health professionals and specialists who promote whole health care and wellness to support system-level changes.
“Family physicians are at the heart of their communities – and they often build relationships with patients that span years, even generations,” said Dr. Furr. “That continuity and trust make them ideally suited to lead the charge in whole health care.”
“They don’t just treat symptoms; they understand the bigger picture; they really listen to patients to understand what is most important to them,” said Dr. Furr. “Family physicians are trained to care for the whole person – across all ages, backgrounds, and conditions – and they know how to connect medical care with lifestyle, behavioral and social support that impact long-term health.”
In collaboration with the Ardmore Institute of Health, AAFP is working to give family physicians the tools and support they need to make lifestyle and behavioral health interventions an everyday part of their practice.
This includes resources that help physicians address the social drivers of health, implement whole-person care, and ensure their communities have access to healthy lifestyle support and scholarships for family medicine residents to attend the AAFP’s Lifestyle Medicine conference, which “equips the next generation of physicians to lead in promoting long-term, community-based health.”
AAFP is the recipient of grants from the Ardmore Institute of Health and the Healing Works Foundation that are amplifying the voices of family physicians and shaping a future centering care on health and wellness.
“Together, the organizations will explore how payment models and training programs must evolve to ensure that whole health strategies are scalable and sustainable for all primary care physicians and practices,” said Dr. Furr.
Whole Health Projects
The AAFP’s Whole Health pilot projects aim to examine how family and primary care physicians can increase their impact on community health and wellness through Whole Health Care.
The projects increase awareness for Whole Health approaches among the healthcare community by leveraging existing materials and resources and providing support and technical assistance to family medicine practitioners. Each medical practitioner documents lessons learned and disseminated findings across public health, lifestyle medicine and family medicine audiences.
The anticipated outcomes of the Whole Health projects has been to increase the availability and access to technical assistance, products and other resources, increase awareness and understanding of whole health concepts among AAFP members, increase awareness of findings and available tools and strengthen the health care system infrastructure.
AAFP aims to broaden the primary care community’s understanding of whole health and lifestyle medicine through the information and lessons learned in the pilot projects using the six pillars of lifestyle medicine as foundational knowledge for participating physicians. The whole health approach empowers patients, families and communities to focus on social determinants of health in addition to treating traditional risk factors for disease.
The first of AAFP Whole Health pilot projects are currently taking place in the U.S. cities of Springfield, MO, Phoenix, AZ and Columbia, MD to understand how family physicians can best impact the lives of patients outside the clinic.
Facilitating Whole Health
Dr. Julia Flax, of CoxHealth Medical Center in Springfield, partnered with Ozark Food Harvest and Umoja Food for Health to develop a Whole Health pilot project that incorporates lifestyle medicine and whole health approaches for individuals with food insecurity by supplying prescription food boxes to her practice’s patients.
“Our motivation for joining the AAFP’s Whole Health program was deeply rooted in the program’s core objectives: integrating whole health approaches, focusing on lifestyle medicine, and addressing social determinants of health through community collaborations,” said Dr. Flax.
The prescription food boxes contain medically tailored meals customized by a registered dietician with nutritional guidelines for patients with diabetes and heart disease. Boxes are delivered directly to the patient’s home.
“A key innovation is the direct-to-home shipping of these food boxes, which eliminates transportation barriers,” said Dr. Flax. “Each box also includes a pre-paid debit card for fresh produce, empowering patients to choose their own healthy options and actively apply their lifestyle medicine education in their daily lives.”
Patients at CoxHealth are being informed and educated about the Whole Health approach through several integrated methods.
“Patients are identified for this project after assessing their needs through a health-related social needs assessment conducted by our population health care navigators,” said Dr. Flax. “It’s these care navigators who then inform patients about this program and guide them through the entire experience.”
The program’s emphasis on a holistic approach to care allowed CoxHealth to tackle a critical social determinant of health by focusing on nutrition, ultimately aiming to improve its patients’ overall health in a comprehensive way.
“As a direct result of the Whole Health pilot, we’ve significantly transformed aspects of patient care,” said Dr. Flax. “We’ve enhanced our integration of lifestyle medicine by leveraging a strong partnership with a local community organization.”
The collaboration with AAFP enables CoxHealth to provide the community with tailored prescription food boxes, in addition to comprehensive lifestyle medicine nutrition education, therefore improving the health outcomes of underserved patients.
“Our population health team was already proactively integrating whole-person care into patient services,” said Dr. Flax. “This pilot perfectly aligned with our goals, offering a structured framework to directly address food insecurity among our underserved patients with diabetes and hypertension.”
Overcoming barriers
In the Phoenix Whole Health: Pilot Projects, Dr. Jose Rodriguez-Garcia at Spectrum Medical Care Center worked with the ‘Chicanos por la Causa’ and ‘one·n·ten’ outreach programs with a community aim to help prevent HIV transmission within the Phoenix LGBTQ+ community while improving social connection and stress management strategies among participants.
In Columbia, Dr. Lindiwe Greenwood of Total Renaissance Wellness partnered with ‘HopeWorks’, Healing House’ and ‘Edesiagurl’ to provide wellness programs integrating nutrition, physical activity, social connection and stress management for survivors of domestic and sexual violence.
Each of the AAFP pilot projects emphasized the importance of addressing social drivers for health through holistic care and leveraging community resources and partnerships to help meet patient’s needs.
“We also learned from the projects that strong partnerships and direct communication channels between health care workers and community organizations are crucial for streamlining processes and overcoming barriers when delivering Whole Health Care,” said Dr. Furr.
“This pilot has generated significant success stories and demonstrable impact, strongly evidenced by the profound feedback from our patients,” said Dr. Flax. “Their comments highlight a direct and positive shift in their ability to access and consume healthy foods, which is a critical outcome for addressing food insecurity. For instance, patients have shared that the boxes were ‘a game changer with how expensive healthy food has gotten’ and ‘really helping me get by’ when other assistance was cut.”
Beyond increased access to nutrition, the CoxHealth project has directly influenced healthier eating habits and culinary exploration for Dr. Flax’s patients. Of the 68 patients meeting the criteria to participate in the prescription food box program, 45 have enrolled, leading to a 66.2% engagement rate, according to AAFP data.
“Patients have reported ‘reaching for healthier items to cook and snack on,’ and discovering new food favorites. The convenience of the microwaveable meals in the boxes was also greatly appreciated, with one participant noting, ‘The microwaveable meals have been surprisingly tasty and keeping me away from fast food while at work.’
Dr. Flax says that the project demonstrated the significant impact of addressing social determinants of health through a whole-person approach.
Using electronic health records and health-related social needs screening tools allowed Dr. Flax and her team to precisely identify patients with specific conditions such as diabetes mellitus and hypertension who experience food insecurity to address the nutrition pillar of lifestyle medicine.
“Moving forward, we are formalizing our measurement of both qualitative and quantitative impact. We are now conducting follow-up ‘Starting the Conversation’ surveys, in addition to collecting biometric readings and HgbA1c levels to more formally track the health outcomes and overall effectiveness of this vital program,” said Dr. Flax.
“The success of this pilot, strongly reinforced by patient experiences, has led us to now focus on scaling this model to ensure more patients receive the comprehensive care they deserve,” said Dr. Flax.
Dr. Furr says that hearing the real-world success stories from the pilot project initiatives can inspire other family physicians to implement similar programs in their own practices.
“These stories demonstrate the positive impact of integrating lifestyle medicine and community collaboration, fostering a collaborative, equitable, holistic healthcare environment,” said Dr. Furr.
Success in collaboration
A key component of effective primary care is recognizing that a patient’s life circumstances play a central role in their health outcomes.
AAFP continues to work to solidify primary care’s place in a health care system focused on achieving whole health rather than by solely treating disease. In practice, this means building relationships with community organizations, nonprofits, local organizations, and more to promote the health and well-being of the community.
“We have learned that strong partnerships and direct communication channels between health care workers and community organizations are crucial for streamlining processes and overcoming barriers when delivering Whole Health Care,” said Dr. Furr.
The AAFP Whole Health: Project Plan is designed to be replicated by any physician seeking to develop or expand a partnership with a community organization. The project plan template from AAFP, a guide focusing on identifying outcome goals for project’s strategy, is designed to be used by any physician who wants to start or grow a partnership.
The addition of partnership impacts to the model helps physicians create a plan for working with and within community groups, according to AAFP.
AAFP has also compiled a list, known as the Whole Health Guide, of valuable resources and tools to help family physicians make collaboration successful, including case studies, research projects, personal health inventories, and more.
“With the right tools, training, and support, family physicians can bring Whole Health to life in their practices every day – helping patients thrive, not just survive,” said Dr. Furr.