At the risk of sounding too bold, I am just going to throw this out there: Chiropractors are making a quiet, but significant contribution to our nation's health. Why quiet? Few people outside of our profession know how much public health work we do every day in chiropractic practice.
About What We Do
The Practice Analysis of Chiropractic 2010 (formerly the Job Analysis of Chiropractic) is compiled by the National Board of Chiropractic Examiners every five years. It offers a summary of what is happening in chiropractic practice, what kinds of patients we see, what techniques we use, what additional interventions we do, etc. This document says a lot about the important public health work that chiropractors do every day in practice. Another important document comes from the "Healthy People" project in the form of Healthy People 2000, Healthy People 2010, and the draft Healthy People 2020 documents. For those of you who haven't reviewed the Healthy People documents, they are considered the main "road map to health" in America. They list the main indicators of our nation's health, what our goals are to improve in these top areas, and how we might get there. Let me now explore the contrast between what we are doing in practice and how we tell others about our contribution to health in America, using these documents as resources.
| What We Do in Practice | Using the Language of Health to Describe It |
| Teaching patients to avoid hurting their backs | Injury prevention |
| Recommending changes in lifestyle | Health promotion |
| Taking a patient's blood pressure | Preventive screenings |
| Recommending that patients quit smoking | Smoking cessation recommendations |
Of course, first and foremost, chiropractors adjust the spine and other joints of the body (depending on their state's scope of practice and the chiropractor's philosophy). One important impact of this chiropractic care is the reduction of back pain. Back pain is one of the top health concerns listed in the Healthy People 2010 document and will reappear as a major health concern in the Healthy People 2020 document. Quietly, chiropractors are playing an important role in meeting the nation's Healthy People goals.
The Importance of Speaking the Language
But are we speaking the language of health? The language that all health professionals speak and the context in which health policy decisions are made? Obviously and unfortunately, not so much. Unless we speak of chiropractic care as contributing to the Healthy People goals, no one will know that we have a role to play.
Beyond the chiropractic adjustment, it gets even more imperative that we learn to speak the language of health. According to the Practice Analysis of Chiropractic, DCs are doing the very activities recommended in the Healthy People goals. For example, one objective listed in HP 2010 is to increase the proportion of physician office visits for chronic health diseases or conditions that include counseling or education related to exercise. I am fairly certain that we see some of these folks in our practices! According to the Practice Analysis of Chiropractic 2010, 96.5 percent of chiropractors recommend physical activity to their patients. It seems we are "walking the walk," but we may not be letting people know that chiropractors are significant contributors to meeting this important Healthy People goal. By speaking the language of health, particularly with other health care professionals, we position ourselves to be increasingly valued as important members of the health care team.
Another excellent example relates to the topic of nutrition or healthy dietary practices. About 95 percent of chiropractors in the Practice Analysis report that they give advice on nutrition to their patients. Healthy People sets this goal for our nation: Increase the proportion of physician offices visits that include counseling or education related to nutrition or weight.
I honestly believe that participating in positive public health practices are so second-nature to chiropractors that we fail to realize what a big deal it is. The pressures that managed care has placed on medical professionals has severely limited the amount of time that doctors can spend on promoting health and wellness. While chiropractors have also felt the financial squeeze of functioning within this health care system, we continue to do a great deal of health promotion with our patients. Since health promotion and prevention practices are increasingly valued in health care, it is time for chiropractors to speak out loudly and clearly and say, "Hey, we were all about health promotion before health promotion was cool!"
Steps to Recognition
So, how do we get the word out about our significant contributions in this area? A multi-faceted approach may be essential to ensuring that our message will be heard by the right ears. Here are some simple steps to help our profession become a more recognized contributor to the nation's health efforts:
- Chiropractors must familiarize themselves with nationally known public health documents, like Healthy People 2010, Healthy People 2020 (when it comes out), and the Guide to Clinical Preventive Services.
- We should speak about what we do in chiropractic practice in the context of these health documents.
- We must become fluent in the language of health (see table)
- We must conduct research on the depth and impact of our health promotion and prevention efforts in chiropractic practice and.
- We must write about what we do.
- We must become active members in national health organizations such as the American Public Health Association.
Gathering data on how influential our health promotion and prevention efforts are in practice, may offer some strikingly important insight into the influence of chiropractors on the nation's health practices. It's time for us to speak out and have our contribution to the nation's health not be quite so quiet. Becoming a part of the American Public Health Association's (APHA) Chiropractic Health Care Section may be the most important step of all. Through involvement in this group and attendance at their annual conferences, many chiropractors like me have learned fluency in "health speak" and have had opportunities to write and present about what chiropractors do in the context of Healthy People 2010 and other important documents. Opportunities happen for people who care to join APHA.
For example, I have personally met the last four surgeons general of the United States and gotten to talk to them about chiropractic. This would not be possible without membership and active participation in APHA. In May of this year, several chiropractic APHA members and leaders in the World Federation of Chiropractic (WFC) met the current U.S. surgeon general, the secretary of the Department of Health & Human Services, and the director of the U.S. Health Resources and Services Administration at the WHO headquarters in Geneva during the annual WHO World Health Assembly. Every one of these top leaders in government and health encouraged chiropractic doctors to get more involved in public health.
So, for anyone who envisions a future in which chiropractic is considered a key player in our nation's health care, becoming involved in APHA is a crucial step. We in APHA's Chiropractic Health Care section look forward to welcoming you and seeing you this November in Denver at the APHA annual conference.
Resources
- National Board of Chiropractic Examiners. The Practice Analysis of Chiropractic. www.nbce.org/pdfs/practice-analysis/chapter_09.pdf
- Healthy People 2010. www.healthypeople.gov
- Healthy People 2020 (draft for public comment). www.healthypeople.gov/hp2020
- The Guide to Clinical Preventive Services. www.ahrq.gov/clinic/uspstfix.htm#pocket
Click here for previous articles by Rand Baird, DC, MPH, FICA, FICC.
Dr. Lisa Zaynab Killinger is past section chair of the APHA's Chiropractic Health Care section and director of diagnosis and radiology at Palmer College of Chiropractic. Contact her with questions and comments at
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