Health Coaching In Primary Care

What is Healthism?

Healthism, a term coined by Robert Crawford in 1980, refers to the preoccupation with personal health as the primary focus for achieving wellbeing. It promotes the idea that individuals have complete control over their health outcomes through lifestyle modifications. However, this perspective fails to acknowledge the broader social, cultural, and environmental factors that influence health, such as genetics, poverty, discrimination, and systemic inequities. Healthism places the blame on individuals for their health status, often leading to feelings of guilt and inadequacy when efforts to achieve optimal health fall short.

The Problem with Healthism
 

Healthism's narrow focus on individual responsibility disregards the systemic issues that contribute to health disparities. Poverty, lack of access to healthcare, discrimination, and other social determinants of health significantly impact an individual's well-being. Moreover, healthism perpetuates the idea that there is a moral hierarchy based on health status, stigmatizing those who do not conform to the idealized standards of wellness. This can lead to exclusion, discrimination, and the reinforcement of harmful stereotypes. Fariha Roisin, author, poet, and Queer, Brown Muslim woman, explores her wellness needs while scrutinizing how the industrial wellness complex fails BIPOC and LGBTQ communities. Her new book, “Who Is Wellness For? An Examination of Wellness Culture and Who It Leaves Behind", she argues that healing must occur at the collective level by becoming accessible for all. Otherwise, she points out; it is not wellness or healing. (Chan-Malik, 2022)

“Wellness isn’t for anyone, if it isn’t for everyone.”

Who Is Wellness For? — FARIHA RÓISÍN

If healing is not for everyone, she states, it’s paradoxical. She argues that we don’t need
wellness, “We need a justice-based ethos of reciprocity, compassion, and care.” (Chan-Malik, 2022).

Lucy Aphramor, Ph.D., R.D. from the Well Now Program articulates healthism as:

1. Healthism assesses an individual’s value based on their health status. A worldview positioning health as an individual’s asset and obligation, prioritizing the individual quest for health above all else.
2. Healthism overlooks the influences of all of the social determinants of health such as poverty, environmental factors, subjugation, historical transgressions and health equity/health treatment.
3. Healthism keeps things the way they are, leads to blaming people who are suffering and gives advantages to privileged people increasing health inequalities and self-oppression.

Examples of Healthism

Moralizing Food

In society, we often moralize food by assigning values of "good" or "bad", "right" or "wrong", to different foods and eating behaviors. This can manifest in various ways. Have you ever heard the phrase “only shop the perimeter of the grocery store” or “don’t buy any product where you can’t pronounce the ingredient” or “only eat clean food”. These statements add a moral judgment about food choices, associating virtue with eating certain foods and guilt or failure with other foods.

Moralizing Physical Activity

Access to exercise opportunities (like gyms and parks) and time to exercise are often linked to socioeconomic status. Moralizing exercise can, therefore, intensify social inequalities by privileging those who have the resources to exercise regularly. Moreover, people who exercise regularly are often seen as more disciplined, responsible, and morally upright, while those who do not engage in regular physical activity may be viewed as lazy, irresponsible, or lacking in willpower.

The Cult of Thinness and Body Shaming

Healthism often conflates health with thinness, equating a particular body size and shape with optimal wellbeing. The wellness industry capitalizes on this by promoting weight loss programs, diet plans, and fitness regimens that prioritize achieving a specific body ideal. This emphasis on appearance can lead to body shaming and the perpetuation of harmful stereotypes. It fails to recognize that health is not determined solely by body size and that individuals can be healthy at any size. We’ve known this for decades but still can’t seem to embody it.

Industry and Healthism

The wellness and health coaching industries can play a significant role in perpetuating healthism. It markets products, services, and lifestyles that promise to improve's health and wellbeing. However, this industry often fails to address the underlying systemic issues that contribute to health disparities. Instead, it promotes the idea that individuals have complete control over their health outcomes through purchasing wellness products and adhering to specific lifestyle choices. This narrow focus places the burden of responsibility on the individual, ignoring the need for systemic change or better yet, taking action toward reducing this systemic problem.

Lack of Diversity, Equity, and Inclusion

One of the key criticisms of the wellness and health coaching industries are its lack of diversity, equity, and inclusion. Mainstream wellness narratives often exclude marginalized communities, reinforcing existing power structures and perpetuating health disparities. The industry tends to prioritize and cater to a narrow, predominantly white, and affluent demographic, neglecting the unique health needs and experiences of individuals from different backgrounds. This lack of representation and inclusion perpetuates healthism and fails to address the systemic inequities that contribute to health disparities.

Promoting a Holistic Approach to Well-being

To address the critique of healthism and foster a more inclusive health coaching practices, a holistic approach is needed. This approach recognizes that health is influenced by a multitude of factors, including social, cultural, and environmental determinants. It advocates for systemic changes to address health disparities and promote equity and inclusion. Here are some key principles that can guide the shift towards a more holistic approach:

• Intersectionality: Recognize and address the unique experiences and health needs of individuals from diverse backgrounds, considering the intersections of race, gender, sexuality, disability, and socioeconomic status.
• Social Determinants of Health: Acknowledge the impact of social determinants of health, such as poverty, discrimination, and access to healthcare, and work towards addressing these systemic issues.
• Body Neutrality: Shift the focus away from appearance and promote body neutrality, recognizing that health is not determined solely by body size or shape. Emphasize self-acceptance and body autonomy.
• Evidence-Based Practices: Promote evidence-based practices and interventions within the wellness industry, ensuring that claims are supported by scientific research and rigorous evaluation.
• Inclusive Representation: Prioritize diversity, equity, and inclusion within the wellness industry by amplifying marginalized voices, featuring diverse faces and bodies in marketing and content, and actively working to dismantle barriers to access and participation.

Conclusion

Healthism, with its emphasis on individual responsibility and narrow focus on physical health, overlooks the complex interplay of factors that influence wellbeing. The critique of healthism highlights the need for a more inclusive, equitable, and holistic approach within the wellness and health coaching industries. By addressing systemic issues, promoting diversity and inclusion, and embracing evidence-based practices, we can foster a non-judgemental partnership and space that truly supports the wellbeing of all individuals, regardless of their background or circumstances. It's time to move beyond healthism and create a culture of wellbeing that is truly empowering and inclusive.