1 Wholism, Integrative Health Care, and Decolonization: An Overview

There is no reason that we can’t be as humanly sophisticated
as we are technologically sophisticated.

– Arthur Kleinman, MD & Medical Anthropologist, Harvard University

Integrative Health Care (IHC) is an approach that supports a much needed return to holism, that can help our health care systems to stabilize, heal, and decolonize.  In recent centuries,  these systems have been based on the ‘Western’/biomedical/allopathic system that has came to be considered ‘conventional’ health care in colonized parts of the world (Rakel & Weil, 2023). While biomedicine has had amazing success in addressing acute health conditions and injuries, it has had less success with preventing and treating chronic conditions; at the same time, it has become increasingly less holistic and person-centered (Berry et al., 2024).  As the limitations and inequities of this approach are becoming more widely recognized, there is a growing movement to transform our individual and collective health care, making it more effective and sustainable for consumers and caregivers alike (Allan & Smylie, 2015; Berry et al; Weil, n.d.)

This chapter briefly explores the inseparable concepts and processes of holism, IHC, and decolonization, highlighting the urgency of related action and offering examples of how such action can be initiated.

Holism

Holism is an approach that focuses on the whole person and is concerned with the inseparable connection between mind, body, spirit, emotion, community, and environment (Dunn, 2019; Rakel & Weil, 2023).

Most cultures in the world are grounded in a holistic worldview and way of being, particularly those who have been able to remain in touch with, or return to, their deep connection and ‘right relationship’ with all living things (Baskin, 2022; Dunn, 2019). Such a worldview supports collective wholeness, wellness, and healing.

Healing involves an often ineffable process of returning to wholeness and optimal wellness, fostered when harmony, balance, and trust are present within ourselves and our environment (Berry, 2024; Quinn, 2019; Sadat Hoseini et al., 2023). Such holistic conditions activate a ‘healing response’ – a phenomenon increasingly evident in the field of psychoneuroimmunology (PNI) wherein such conditions are observed to promote enhanced overall physiological functioning and openness to mental, emotional, spiritual, and relational transformation (Jonas, 2018; Scott Barss, 2012).  Healing itself is defined as “a holistic, transformative process of repair and recovery in mind, body, and spirit resulting in positive change, finding meaning, and movement towards self-realization of wholeness, regardless of the presence or absence of disease.”  (Samueli Institute in Sakallaris et al., 2015, p.40).

Integrative Health Care (IHC)

Let’s re-visit the working definition of Integrative Health Care (IHC) used within this handbook.  IHC is an approach to health promotion and restoration that …

… synergistically blends the best of all relevant evidence-
informed healing practices and professions to provide relationship-based, person-centered care.

… prioritizes activation of healing responses, holistically engaging mind, body, heart, spirit, community, and environment to foster the well-being of all (whether receiving and/or offering care).

… integrates the safest, most effective modalities from the world’s healing systems as chosen by individuals, thus actively contributing to the de-colonization and inclusivity of health care.

(Baskin, 2022; Hunter, Harnett, Chan et al., 2023; Ng et al.; Rakel & Weil, 2023; Scott Barss 2015)

Dr. Andrew Weil, University of Arizona, is widely recognized as the initial proponent of ‘Integrative Medicine’ in North America. The below link features several short video clips wherein he provides further information on its nature, benefits, and principles.

Weil, A. (n.d.) Integrative medicine: Definition, advantages, and principles. 

Another early leader in IHC is Dr. Wayne Jonas. His presentation below describes a ‘whole person’ approach to healing and discusses the related shifts needed in health care.

Jonas, W. (2018a). How healing works and what it means for health care. GW Health  Sciences. 

Health outcomes and implications in Canada are comparable to those outlined by Dr. Weil & Dr. Jonas (both based in the United States). For Canadian data (including that post Covid-19), see:

Health Outcomes · CIHI and PCH PB_EN_0.pdf (rsc-src.ca).

Whatever the jurisdiction, it is increasingly clear that an integrative approach to health and healing needs to be taken if worsening outcomes, health inequities, healthcare system overload, and care provider burnout are to be addressed (CIHI, n.d.; Rakel & Weil, 2023; WHO, 2010).

In recent years, many health care professions have articulated how they can begin to intentionally implement integrative approaches specific to their discipline.  A few examples are featured in the box below. (Of course, a literature review specific to any given profession can reveal many more such samples.)

Decolonization

Decolonization refers to the process of deconstructing colonial ideologies of the superiority and privilege of Western thought and approaches. On the one hand, decolonization involves dismantling structures that perpetuate the status quo, problematizing dominant discourses, and addressing unbalanced power dynamics. On the other hand, decolonization involves valuing and revitalizing Indigenous knowledge and approaches and weeding out settler biases or assumptions that have impacted Indigenous ways of being.

                                                                                   (BC Campus, 2018, p. 6).

The following address by Dr. Rupa Marya invites us to a deeper understanding of decolonization endeavors that are specific to health promotion and restoration.  She speaks primarily from the perspective and positionality of an ally to those most harmed by colonialism in North America (although she and her own family have experienced marginalization and oppression in other contexts).

Marya, R. (2018). Health and justice: The path of liberation through medicine.

Further understanding of decolonization work can be gained from the following interview with Dr. Alika LaFontaine,  President of the Canadian Medical Association (CMA) at the time of Canada’s first National Day for Truth and Reconciliation.  He speaks primarily from the perspective and positionality of an Indigenous health care professional who has experienced and witnessed firsthand the many harms of colonization.

Fontaine, A. (2021). Canadian health care and truth and reconciliation.

As evident in the above resources, the broader social determinants of health and health care itself, currently don’t even offer basic safety to many individuals, especially those who are marginalized (Bourque-Bear, 2023; Lavallee & Harding, 2022; George et al., 2024). Consequently, an integrative approach to health and healing needs to prioritize anti-oppression measures, both at an individual and systemic level (Gebhard, McLean, & St. Denis, 2022; Graham, 2024). As Dr. Marya and Dr. Fontaine powerfully highlight in their above videos, the inextricable relationship between equity and health requires us to actively promote justice in support of every individual’s well-being on every dimension, whether socioeconomic, educational, relational, vocational, nutritional, environmental or otherwise .

Intentional and urgent measures are imperative, as outlined in the following documents:

World Health Organization (WHO) Conceptual Framework for Action on the Social Determinants of Health (2010)

Truth & Reconciliation Commission of Canada (TRC) 94 Calls to Action (2015) 

Without implementation of such measures, the holistic health needs of those who are oppressed and marginalized cannot possibly be met. Therefore, it is vital that readers actively follow the recommendations provided in documents such as the above. Such involvement is particularly important if you are not among those who are currently oppressed and marginalized, as you are well-positioned to leverage your relative privilege in advocating for and with those without it. Becoming an ally can be uncomfortable and very humbling, so it is also vital for you to seek support, mentorship and sources of ongoing learning in relation to such anti-oppression work (Gebhard et al., 2022; Graham, 2024).  

IHC and decolonization are multi-faceted concepts and complex processes that need to be collaboratively explored, understood and implemented within a given community and organizational context (Graham et al., 2023; University of Minnesota Bakken Healing Centre, n.d.). Therefore, several additional resources on IHC and decolonization (including anti-oppression resources) have been included throughout this handbook’s appendices in support of ongoing collaborative learning and adaptation that can best address specific individuals’, communities’ and organizations’ needs.

Initiating Integrative Health Care

Whether we are exploring our own health and healing or supporting others to do so, we need to take a holistic, inclusive approach from the outset if IHC is to be possible. This chapter concludes by introducing two person-centered resources that support holistic self-reflection and/or assessment of one’s individual health needs, preferences, and resources at a given time.

The first resource, The HOPE Note, was created by MD Dr. Wayne Jonas who was featured earlier in one of this chapter’s videos. He offers detailed guidance on his website for its use:

Jonas, W. (2024). The HOPE note: A tool for adding integrative health care to a routine office visit. Healing Works Foundation. 

The second resource is in Appendix E: The WHOLE Care Guiding Questions for Person-Centered Care (Barss, 2024). This resource can help consumers and care providers to understand, communicate about, and begin engaging in IHC practices that best promote and restore an individual’s well-being at a given time.

The resource’s ‘W’ questions especially invite open exploration of what the individual most wants to convey or request in relation to their health care needs and goals. Subsequent chapters highlight ways that the remainder of these questions and the overall WHOLE Care Framework can inform and support ongoing planning, implementation, and evaluation of IHC.