Health Promotion International, Vol. 18, No. 4, 275-278, December 2003
© Oxford University Press 2003 All rights reserved
Twenty-first century health promotion: the public health revolution meets the wellness revolution
When members of the health promotion community discuss the future of health promotion, they tend to neglect a major seminal trend in modern societies: the increasing privatization of health promotion. While they still fight to overcome the marginal shadow existence of health promotion within the health care sector, the private sector has embarked on what one author terms the ‘wellness revolution’ (Pilzer, 2002
). A revolution, according to the Webster Dictionary, is ‘a complete change of any kind’. With the Ottawa Charter, the health promotion community has initiated the third public health revolution and heralded a new public health, which considers health ‘a resource for living’, places it firmly within the context of everyday life and has empowerment at its very core. Yet, 20 years after the Ottawa Charter, is health promotion still ‘the next big thing’? How ready is it to respond to new developments and trends in society, both positive and negative?
Knowledge is one of the driving forces of the wellness revolution, and in modern societies there is an increasingly health-literate population. The steady flow of health education and health promotion from the public sector over the last 30–40 years has indeed contributed to momentous shifts in how modern societies view health, and it seems that at present this influence is felt most strongly in the health marketplace. This is probably the last place where Ottawa-type health promotion wanted to be and where it envisaged its future. Perhaps this also one of the reasons why the dominant health promotion discourse does not adequately reflect these important social and economic developments.
The most visible sign of the ‘wellness revolution’ is the explosion of media that focuses on health and wellness in electronic and print format as specialty magazines, newsletters, books, and a plethora of websites and television programming. Witness any news stand in any OECD (Organisation for Economic Co-operation and Development) country and you will see not only an increasing number of specialized journals for health, wellness and fitness, but you will also realize that major news journals such as Newsweek, Time, Der Spiegel and Focus (to name but a few) are devoting increasing numbers of covers, amounts of editorial copy and even special issues to health and wellness themes.
Research on health and wellness trends is mainly available through private sector market research and usually only accessible for a hefty fee. This in itself reflects what has become a significant economic trend: the promotion of health as a product in a growing private market of health goods and services, where ‘the big bucks’ are predominantly in the distribution of knowledge rather than in the production of goods. Some US economists already propose to consider the health care industry as one of the few drivers of growth in the years ahead. Now calculations indicate that in the US alone, the sales of the wellness industry have already reached approximately $200 billion and that it is set to achieve sales of $1 trillion within 10 years, thus matching the health care industry (Pilzer, 2002).
One major trend in the wellness market is that the line between food, dietary supplements and pharmaceutical products is becoming harder to draw. The Natural Marketing Institute analysed food functionality as one of the top 10 health and wellness trends to watch in the US (French, 2002). Functional foods help manage specific diseases (such as diabetes and arthritis) and address everyday problems (such as stress and low energy). According to a study by the Food Marketing Institute, the purchase decisions of nearly two-thirds of grocery shoppers in the US are motivated by the desire to either reduce the risk of, or manage, a specific health condition (Sloan, 2000). Pharmaceutical companies are increasingly moving into the wellness market with over-the-counter and prescription dietary supplements, preventive medicine and lifestyle drugs.
We suggest that wellness products and services be divided into the following categories: (i) nutritional products and services; (ii) food and beverages; (iii) fitness products and services; (iv) preventative health care; (v) voluntary medicine (including cosmetic surgery and lifestyle drugs); (vi) alternative health care; (vii) resources on wellness (particularly in the media and information sector); (viii) health and wellness tourism; and (ix) wellness insurance (Payne and Kickbusch, 2003). Obviously much could be said about each of these categories, which space does not permit in this editorial. The authors would like to focus instead on the main groups that are targeted by this industry, and include individual consumers, employers and insurance companies, as these could provide the starting point for a strategic response.
CONSUMERS
One key force behind the growth of the wellness industry are the baby boomers, who are reaching their most productive years, and have disposable income and, as they age, disposable time to spend on wellness products. Their key interests lie in quality and choice of products. A study by the General Merchandise Distributors Council and Food Marketing Institute has shown that ‘whole health’, or wellness, consumers have higher than average income and education levels (Mendelson, 1998). Within the baby boomer population, it is the increasing number of females facing menopause who drive the expanding market of women's health and wellness supplies. Soyfoods, for example, which have an FDA (Food and Drug Administration)-approved heart health claim and benefit women's health, is one of the fastest growing segments of the food industry in the US. Sales of soyfoods reached $3.2 billion in 2001, a 16.9% increase on 2000. Soyfood sales in super-/mass-market outlets increased by 26.8% from 2000 to 2001 (SPINS, 2002).
One classification of wellness consumers, the Health and Wellness Segmentation Model, proposes five major consumer segments within the US health and wellness industry (Natural Marketing Institute, 2003). The first category is the ‘well beings’ (17%), or individuals for whom health is a priority across most wellness products, services and lifestyle activities, with little concern for price and brand image. Well-beings are often values-based, early adopting opinion leaders. Next are the ‘food actives’ (23%), who are dedicated to health through food and motivated by the need to be balanced in diet, exercise and nutrition. As late adopting opinion followers, food actives seek long-term solutions through healthy, balanced foods. The ‘magic bullets’ (22%) desire good health but often seek quick solutions (i.e. dietary supplements, or over-the-counter and prescription medicines). They are somewhat of a health-struggling group and are motivated strongly by price and brand image. ‘Fence sitters’ (18%), who are neutral on most health issues, are sometimes driven sometimes by food yet avoid supplementation. This group is not sure how to deal with health and wellness. Finally, the ‘eat, drink and be merrys’ (20%) are concerned neither about their health nor the food they eat, and seek immediate gratification. They do not acknowledge the need for health and wellness products. Health literacy initiatives would have to focus on the last three groups in order to make a difference and produce a health shift.
EMPLOYERS
In the US, employers are the second major driving force of the expanding wellness market. Many studies have shown the economic benefit of workplace wellness/health promotion programmes, and companies are offering wellness programmes to reduce their health care costs and employee absenteeism (Moskowitz, 1999). The European Network for Workplace Health Promotion has been working in the same direction. According to a study by Hewitt Associates in 2001, 93% of US companies are now offering health promotion and management programmes—up from 89% in 1996 (Hewitt Associates, 2002). An interesting example is WELCOA, the Wellness Councils of America [http://www.welcoa.org (last accessed May 13, 2003)], which is a coalition of >900 organizations that are committed to promoting healthier life styles for all Americans through workplace health promotion initiatives. WELCOA focuses on building ‘well workplaces’, or organizations dedicated to the health of their employees. The ‘seven benchmarks of success’ that drive its Well Workplace Program read as if taken out of a healthy settings manual, and comprise:
- capturing senior level support;
- creating cohesive wellness team;
- collecting data to drive health efforts;
- crafting an operating plan;
- choosing appropriate interventions;
- creating a supportive environment; and
- consistently evaluating outcomes.
In addition, WELCOA serves as a national clearing house and information centre for worksite wellness. The organization offers brochures, sourcebooks, incentive campaigns, case studies and consulting services to its members. WELCOA also runs an initiative called Well City USA, which aims to engage entire business communities in improving the health and well-being of their workforce. There seems therefore to be a significant similarity in strategic approaches that could be used to drive the health promotion agenda further.
INSURERS
Many of the major health plans in the US offer discounted wellness services through collaboration with wellness companies (or providers) that supply such products and services. These products and services range from discounted vitamins and gym memberships to savings on massage therapy and cosmetic dentistry. In many cases, wellness services are listed on the health plan's website, which includes information on the health benefits of the product/service, the discount available, and a link to the wellness company's website (with a disclaimer as to the health plan's lack of affiliation with the contractor). Thus, it appears that the wellness company is often a completely separate entity that has contracted with the health plan to be listed as part of the wellness programme.
Certain wellness companies are common among different health plans and even among competing health plans. Such wellness companies include GlobalFit for fitness services and Healthyroads for information services, wellness products, alternative healthcare providers and relaxation therapy. As one analyses the wellness products and services discounted by health plans, it is clear that no great separation is made between health checks and screening, disease management and preventive services, or health promotion and wellness. Indeed the overlap and ‘pluralism’ seems to be the defining criteria of an approach where the final choice is left to the consumer. It seems that a range of European health insurers are moving in the same direction. An attempt in Germany in the 1990s to make health promotion a key responsibility of the health insurance system was retracted in a series of political trade-offs.
WHAT DOES ALL THIS MEAN FOR HEALTH PROMOTION?
All the above is just the tip of an iceberg. The move towards the commercialization, privatization and individualization of health is one expression of the larger trends in modern societies. It widens the debate from the classic approach to regulate industries that produce ill health (such as tobacco or junk food) and to educate communities to ‘increase control over their health and its determinants’ towards new types of strategies and policies. There is a need on the one hand to protect consumers from deception, fraudulent claims and harmful products, and on the other to create knowledgeable consumers who can exercise choice in a highly unregulated health and wellness market. High health literacy will become even more essential.
Concerns over the lack of quality control of products and services has been brought into stark relief in Australia in 2003, where one of the largest producers of alternative medicines, PAN Pharmaceuticals, has had their license withdrawn by government. A gross lack of quality control, fraudulent record keeping and the distribution of a product that actually caused physical harm has led to hundreds of medicines being recalled throughout the country and internationally. Health promotion agencies will need to consider a new role of stewardship in such an environment by addressing issues of quality and equity. While many countries are moving towards two-tiered health systems, they also might already be well on their way to two-tiered health promotion where access through the market makes healthy individuals even healthier, and leaves those with low health purchasing power behind.
On the other hand, the interest of the market in health and wellness offers opportunities for new approaches, partnerships and large-scale health literacy initiatives that have not existed before. In some cases a market model could increase the attractiveness of health promotion messages and make them accessible to groups that have been difficult to reach. The new wellness and health market also gives a new dimension to the debate on social marketing that has taken place in the health promotion community: now there is actually a health and wellness market that competes for consumers with positive health and lifestyle messages. Does this mean that the health promotion community should leave the individual component of health promotion to the market and concentrate on the regulatory, equity and community dimensions?
One interesting argument from the wellness industry advocates that the wellness business is both a reaction to ‘the tyranny of the sickness and the food industry’ and a solution that can counteract the ‘sickness-producing industries’ by engaging consumers in healthy products and services instead. This includes a call for policy measures such as moving subsidies from sickness-producing industries to the wellness sector in order to make wellness affordable, to invest in health and to explore new types of tax relief related to health and wellness. What new kinds of insurance models and health plans could emerge based on a health rather than a sickness paradigm?
In summary we are suggesting that the health promotion community:
- begins to take account of this extensive new health and wellness world ‘out there’, possibly through discussions at the Melbourne 2004 conference and in this journal;
- conducts health promotion research that analyses the strategies and the impact of this industry;
- embarks on a discourse on the pros and cons of the wellness industry and engages productively with this industry;
- develops proactive strategies and policies of support and protection for consumers; and
- explores incentives, regulation and quality control with respect to the wellness industry.
In other areas of social life, society has seen what enormous power the market and consumers can exert. It is time to explore if and where the public health and wellness revolutions can meet to produce better health.
REFERENCES
French, S. (2002) Top 10 health and wellness trends to watch. Natural Foods Merchandiser, June. Http://www.naturalinvestor.com/nfm-online/nfm_backs/jun_02/trends.cfm (last accessed April 22, 2003).
Hewitt Associates (2002) Health and Productivity Programs Continue to Grow in Popularity as Health Care Costs Rise. July 2002 press release. Http://was.hewitt.com/hewitt/resource/newsroom/pressrel/2002/07-15-02.htm (last accessed April 25, 2003).
Mendelson, S. (1998) Selling wellness. Supermarket Business, 53, 65.
Moskowitz, D. (1999) The bucks behind the wellness boom. Business and Health, 17, 43.[Medline]
Natural Marketing Institute (2003) Health and Wellness Segmentation Model. 2003 Health and Wellness Trends Report. Http://www.nmisolutions.com/hwtd_segment.html (last accessed April 24, 2003).
Payne, L. and Kickbusch, I. (2003) The Wellness Industry: Facts, Trends, and Implications in the United States and Europe. Background report on wellness. Unpublished.
Pilzer, P. Z. (2002) The Wellness Revolution: How to Make a Fortune in the Next Trillion Dollar Industry. John Wiley and Sons, New York.
Sloan, A. E. (2000) The top ten functional food trends. Food Technology, 54, 33–62.
SPINS (2002) Soyfood Sales Hit $3.2 Billion Bolstered by Strong Mainstream Sales. 2002 press release. Http://www.spins.com/news/index.htm (last accessed May 27, 2003).
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