“Good health begins at home.” That’s more than just an old adage.
Throughout the past three decades, public health data has shown that the conditions of where we’re born, live, work, and age explain why some Americans are healthier than others. But the healthcare system has been slow to address the social determinants of health in the care that it provides.
“We know about the disparities in death risk based on the zip code in which you live,” explains Karen Lawson, MD. “But physicians are trained to understand pathology — what’s broken physiologically — and to use certain tools to intervene to stop a patient from suffering from symptoms that don’t feel good, or to stop progression and development of worsening symptoms.”
“Nothing that we do is about moving further upstream and making people healthier than they were before they got the symptom,” explains Lawson, who is Co-Director of the Bakken Center’s Integrative Health and Wellbeing Coaching Program.
The United States medical model and its care practices — such as running labs and checking diagnostics such as temperature and blood pressure — are based on Eurocentric traditions, beliefs, and mindsets. “These racial underpinnings lead to misunderstanding of and inadequate treatment of many of those who seek medical care in our system,” says Theresa Nutt, Co-Director of the Center’s Integrative Health and Wellbeing Coaching Program.
“Health has become largely about the body and mind in our western culture, which leaves out a lot of a person's experience as well as resources for healing,” she adds. “There is not a broad understanding of health and what contributes to it, for instance dance, art, and cultural healing practices that are integral to different cultural models of health and healthcare.”
Bridging the Gap
Enter health coaches. “Coaching is a collaborative approach, “says Solange Monono, a national board-certified health and wellness coach at Northpoint Health and Wellness Center in Minneapolis, Minn. “We ask what the patient thinks rather than just telling them what to do.”
Since providers in clinical settings have limited time to spend with patients, coaches can offer continuity of care and guide patients toward successful behavior change.
Coaches also build rapport with patients in a way that other medical providers can’t. They have time to dig deeper into the patient’s life and health history to uncover and address challenges that may be inhibiting a patient’s wellbeing, build their confidence, and get them engaged in their health and healthcare.
“Our job requires us to address socio-economic issues, food insecurity issues, or abusive relationships before we can begin to help people meet their own health goals,” Monono says.
But what if you don’t have access to a health coach or even know they exist? “A majority of minority populations have never heard of health coaches because there’s no access to that kind of resource,” Monono says.
Improving access is essential if coaches are going to be able to shift the health care paradigm toward patient-centered care. To do this, Monono suggests reaching out to providers, frontend staff, and the patient population to increase the profession’s visibility.
Monono argues that boosting coaching’s visibility to underserved communities is a way to increase diversity in coaching, because being impacted positively by coaching can inspire someone to become a coach and take their skills and experience back into their community.
Improving Accessibility
Programs like the Center’s Integrative Health and Wellbeing Coaching Program teach coaches an important skill set they can use to guide people into figuring out how to improve — and even transform — their lives.
Working in partnership with Integrative Health Clinic of Minnesota, the program is committed to providing integrative health coaching to underserved populations.
In order to overcome a massive barrier to recruiting a diverse pool of students — finances — two $1,500 scholarships are awarded by the Bakken Center for Spirituality & Healing annually. More opportunities for financial assistance may become available in Fall 2021.
That’s good news to Jamie Hazelton, a program graduate and founder of Whole You Health. “I believe the biggest way that we can cultivate diversity into health and wellness coaching programs is by making it cost-effective,” she says. She notes that the trans community, for example, suffers high levels of work-force discrimination, making it challenging to afford basic necessities and medical care — and putting higher education out of reach.
Co-Directors Nutt and Lawson also work on boards at the state and federal levels to increase awareness about coaching’s ability to improve health outcomes and advocate for health coaching to be paid for by insurance companies.
Representation is Critical
They’re also keenly aware that they need to improve diversity among the ranks of their own student population. To date the program has graduated 114 health coaches since its inception in 2005 — most of whom are well-educated white women.
That’s not surprising to Reverend Doctor Shawn Moore, PhD, Adjunct Professor at Bethel University. “Modern day coaching is a Eurocentric phenomenon,” he explained during a recent symposium held by the Center titled, “Addressing Inclusion in Coaching: Advancing Health and Wellness in a Diverse World.”
Reverand Doctor Shawn Moore and Dr. Jill Greendeer
Moore says that a key to improving diversity in health coaching is recognizing that we live in a racialized society. (Racialization is the process of ascribing ethnic or racial identities to a relationship, social practice, or group that did not identify itself as such).
“Racialization is like the air we breathe,” agrees Jill Greendeer, PhD, at the University of Minnesota School of Nursing and graduate of the Integrative Health and Wellbeing Coaching program. “We must be aware of those things as a coach.”
Boosting Outreach
Efforts to diversify the program’s student body are underway. “In order to recruit students from diverse populations, we’re partnering with the University of Minnesota Graduate School of Diversity to increase awareness of the health coaching program,” says student services specialist Christina Owen.
Owen also utilizes the National Name Exchange (NNE) — a consortium of fifty-five nationally-known universities that collect and exchange the names of talented undergraduate students from underrepresented populations. “The purpose of the NNE is to ensure that participating universities continue to identify qualified students who could be recruited to graduate programs at participating institutions,” Owen explains.
Representation of diverse groups in coaching is imperative, says Moore. If clients don’t have to spend time explaining things like their cultural norms and values to a coach, they have more time to focus on discussing how to meet your own healthy living goals.
That means implicit bias training is imperative for successful coaching. “If you’re not aware of your bias, you take away the wholeness of the person you’re coaching,” Greendeer says.
The essence of coaching, Monono says, is “meeting people where they are and sitting there in uncomfortable spaces.”