WELLNESS: ITS ORIGINS, THEORIES AND CURRENTAPPLICATIONS IN THE UNITED STATESJana Stará, Michal CharvátAbstract: In the Czech setting, wellness is known as a synonym of spa facilities, butthe former concept of wellness, as it evolved in USA in the 70 s, is a holistic model of healthwhich serves as an alternative to traditional perception of human health. Knowledge of theorigins, former theories and current application of wellness is necessary for healthydevelopment of this industry, not only in the Czech Republic.Key words: Wellness, holistic health, workplace wellness, wellness coaching,wellness tourism.1 IntroductionA usual question to open this article could be: What is wellness? The term wellness isvery often used by healthcare professionals, as well as by the general public, but usually itlacks deeper understanding. Absence of generally accepted definition of wellness leads to aconfusion among both professionals and clients and it decelerates the development of a soundbody of scientific knowledge related to wellness. At the same time, the deficiency of clearexplanation might lead to misinterpretation of the whole concept of wellness (Corbin &Pangrazi, 2001).In scientific literature the term wellness is used in the same context as well-being.Authors Gord Miller and Leslie T. Foster, in their article “Critical synthesis of wellnessliterature” (2010) confirm that those terms are being used interchangeably. We can also findsimplistic explanations of the evolution of the term wellness, such as connecting words wellbeing and fitness (Poděbradský, 2008), where the loose translation would be “move and beOK”. There are no evidences of such formation of the word “wellness” in the originalliterature, and from its nature, this explanation is far too reductionist. It limits the holistic andmultidimensional concept of wellness to only two dimensions – physical and psychological,even though models of wellness have several dimensions, according to Stanford ResearchInstitute (2010), some have up to fourteen dimensions.

To reveal the meaning of wellness, it is not enough to study the evolution of this word(we would find out that the Oxford English Dictionary dates the first use of this word to1654), more importantly, it is necessary to study the origins of the whole concept of wellness.2 Ancient origins of wellnessOriginal sources of wellness ideas can be found in deep history, thousands years ago.Traditional cultures had sophisticated health care systems that respected and aimed forbalance of human body, mind and spirit and perceived human health from its holisticperspective (Cohen, 2010; Strohecker, 2010).Indian Ayurveda, traditional Chinese medicine, or ancient Rome and Greece, who putfoundations for today’s medicine and often to the mentioned ideal of Kalokagathia - thesetraditional systems had many aspect in common. Except for curing a disease, they focused onits prevention and among other included as well some religious of philosophical system,which interfered with the societal context. Common was also the individual approach to thepatient, so different from current medicine.These traditional healthcare systems emphasized one’s lifestyle – nutrition, physicalactivity, quality sleep, moderation, ethical behavior, development of positive thoughts andemotions through prayer of meditation. These are simple tools to keep balance in one’s life,even in the 21st century (Strohecker, 2010).3 Twentieth century – era of modern medicine, societal changes and wellnessHolistic medicine stood for a long time side by side its younger, more “scientific”sibling that we call biomedicine, allopathic medicine or modern health care. Holistic medicinewas a common practice still in 19th century and new therapies like homeopathy, neuropathy,chiropractic or osteopathy were just developing. However, scientific discoveries of LouisPasteur, Robert Koch or Wilhelm Konrad Roentgen moved the modern medicine far ahead.In the first decades on the 20th century, it even seemed that modern science providedanswers to all questions and cures to all illnesses – it was enough to find the right substance.The first sign of more humanistic approach to health care was the definition of heath fromWorld Health organization in 1948. The real shift started in late 1960 s, when the modernmedicine neared its limits. Resistant microorganisms were developing more quickly than newpills and majority of American population was dying on diseases caused not by viruses, butby people’s lifestyles. It was not enough to change the cure, but also to change to way peoplelive (Travis & Callander, 1990).

As stated in the official Healthy People: The Surgeon General's Report on HealthPromotion and Disease Prevention (1979):“The health of the American people has never been better. In this century we havewitnessed a remarkable reduction in the life-threatening infectious and communicablediseases. Today, seventy-five percent of all deaths in this country are due to degenerativediseases such as heart disease, stroke and cancer. [ ] Further improvements in the health ofthe American people can and will be achieved – not alone through increased medical care andgreater health expenditures – but through a renewed national commitment to efforts designedto prevent disease and to promote health” .The positive definitions of health, the attitude of the World Health Organizationtogether with official political documents were the first steps ahead. It changed theperspective from which we perceive human health, and the topic of health promotion andprevention became usual. However, these official statements and documents are “only”recommendations and the path to objectively enhanced quality of life of the whole populationwas very long.This was the starting point and the context of rising wellness movement. The conceptof wellness is an application of the positive definition of health, but according to DonaldArdell ( n.d.), it extends beyond prevention and health promotion. The main goal ofprevention is to avoid illnesses, but wellness aims for a happy, balanced, quality and fulfilledlife. To understand this difference, let’s have a look at former theories of wellness.3.1Halbert L DunnThe first person who used the term wellness in modern context was Halbert L. Dunn,MD, expert in the field of vital statistics. Dunn used wellness as an absolute opposite ofillness. Except for the fact that the Western world divides men on the physical part that iscured by doctors, psychological part, cured by psychiatrists, and spiritual part, cured bypriests. Dunn emphasized also the impact of environment I which certain person lives. (viz.Obr. 1)

Obrázek 1: Health grid (Dunn, 1959)In his Health Grid Model, Dunn takes into account the impact of external factors onone’s wellness and quality of his life. Equally important is the person himself, who shouldendeavor for personal mastery in all aspects of human life. Dunn’s wellness is about usingoptions available at the very moment. The Peak wellness on the right end of the graph is a“performance at full potential in accordance to the individual's age and makeup” (Dunn, 1959,s. 787).Miller (2005) noted that Dunn himself was not a practicing physician, which mighthave allowed him to see health from far deeper perspective than just fighting diseases. As astatistician Dunn more intensely reflected the impact of chronic diseases and demographicalchanges, and thus he called for a new, more integrated approach to human health.The need for change in how we perceive health has to be viewed in the context ofsocietal and cultural changes in the second half of the 20th century. This era entailed changesin understanding the role and position of man in the society and in the world. Dunn summedthese changes up as follows: “It is a shrinking world. It is a crowded world. It is an olderworld. It is a world of mounting tensions.” (Dunn, 1959, s. 786–787) These phenomenons are

valid even today, plus we can add the topic of collapsing healthcare systems, that can’t holdthe onslaught of ageing and chronically ill population that needs to be cured (SRI, 2010).Halbert L. Dunn highlighted the rising numbers of chronic and mental illnessesalready in the 50 s. Together with the neurotic and functional diseases, these are verymalicious, because they don’t directly endanger human life, but they have a huge impact onits quality. Dunn’s ideas were published in 1961 in book High-level wellness, which didn’t getmuch echo on the public, but the book found its way to the hands of JohnTravis.3.2John Travis – the founding father of wellnessJohn Travis, a doctor who displeased his role of almighty physician. Inspired byDunn s ideas, contemporary humanistic psychology and many other influences, Travislaunched the very first wellness center in Mill Valley, California. In this center they offeredan eight- months-long wellness program for 1,500 dollars. The program covered weeklygroup meetings and individual sessions, and the clients learned how to “relax, experiencethemselves, remove barriers, improve communication skills, enhance creativity, envisiondesired outcomes, take full responsibility for themselves and love themselves” (Ardell, 1977,s. 9).Although Travis focused particularly on wellness in practice, he and his colleagueshave developed a tool to assess one’s levels of wellness (named Wellness Inventory), butmore importantly he has developed theoretical models explaining the links between humanhealth, medical care and wellness.Obrázek 2: Illness-wellness kontinuum (Travis & Ryan, 2004)The main objective of the Illness-wellness continuum (viz Obr. 2.) is that mereabsence of illness doesn’t bring wellness, doesn’t mean quality of life, and it is rather aneutral point in the middle of the graph. The modern medicine, labeled the Treatment

paradigm, can bring its patients to this neutral point, meanwhile the wellness paradigmextends over both sides of the continuum. The concept of wellness aims to help people inachieving higher levels of wellness, more quality lives, no matter what their current state ofphysical health is – according to Travis, even physically ill person can live quality life.Obrázek 3: Iceberg model of health and illness (Travis & Ryan, 2004)The second model, the Iceberg model of health and illness (viz Obr. 3), illustrateswellness as a practical application of the above mentioned positive definition of health 1. Thestate of physical health at the top reflects Maslow’s principle of interconnectedness betweenthe dimensions – the tip of the iceberg is a result of fulfilling or suppressing needs on thelower levels.Travis’s wellness center together with his clear theoretical concept of wellness createdthe foundations for rising wellness movement in the United States. From the unfamiliar wordthat was used on the west coast in the 70 s, wellness became a national phenomenon in the80 s, mostly thanks to the work of Don Ardell.3.3Donald B. Ardell – the speaker of wellnessDonald Ardell is the most often heard advocate of wellness thoughts. His dissertationmapping wellness was published in the 70 s and became a bestseller. Since then Ardelldevoted his life to promoting wellness. His approach to wellness is best described by thesentence „Wellness Is Too Important To Be Presented Or Lived Grimly“ (Ardell, n.d.a). Don1The Iceberg model covered the spiritual dimension of health already in 1978, when it was firstpublished. The former WHO definition contained only three dimensions – physical, mental and social. Thespiritual dimension was officially added in 1998.

Ardell has gained broad attention for the wellness ideas and up to these days is an activespeaker.According to Ardell (in Monroe, 2006), “Wellness got stuck in the health field, whichhas more of a disease/treatment framework. But wellness could just as well be founded inpsychology, sociology or even public policy. I think it’s often easier for people to think ofwellness in terms of quality existence rather than health.” Except for medicine, Ardell is afierce critique of corporate wellness programs, but more on that in chapter 4.1 WorkplaceWellness.3.4Bill Hettler – voucher to the academic field and foundation of NWIThe last of the mentioned founders of the wellness movement is Bill Hettler, formerphysician at the University of Wisconsin – Stevens Point who created the first faculty wellnessprogram and introduced the concept of wellness into the academic field. Hettler and hiscolleagues founded the National Wellness Institute (NWI) in 1977, a nonprofit organizationthat connects and provides further education for health promotion and wellness professionalsand organizes annual international conference.Wellness in the context of health promotion, prevention and public health became thena part of university curriculums in the US – for example, the above mentioned university inStevens Point offers an online bachelor program, Science in Health and WellnessManagement.4 Wellness in the 21st centuryAlmost 40 years after its foundation, wellness doesn’t have one broadly accepteddefinition and is explained by many people in many ways (Corbin & Pangrazi, 2001). Sincethe first wellness center on the west coast, the concept became a part of American and globalculture including professionals, clients and scientists – in scientific databases there arethousands of records under the term wellness (Miller & Foster, 2010).Especially in practice, wellness is often simplified and becomes a synonym ofeverything that makes one “well and healthy”. There is wellness pet food, wellness fitnesscenters and even gardening companies offering “wellness” services. This trend isinternational, as in US as in Czech Republic one can buy wellness shower gel or wellness tunafish.Except for this marketing misuse of the term, Don Ardell (2004) defines more deepdistinction between various interpretations of wellness concept. He describes it as a schism

between quasi-spiritual wellness and secular wellness. „The former [quasi/spiritual wellness]is based on faith, emotions, supernaturalism, the recovery movement, wishful thinking,weepy/swaying hand-holding, New Age mysticism, guru-worship and all things antediluvianand reprehensible; the latter [secular wellness] is based on science, personal responsibility,critical thinking, exercise and fitness and a conscious quest for added meaning and purpose inlife“.In the midst of these two poles of current wellness movement we can find variousapplications of wellness ideas, and in the following chapter we will focus on the mostprevalent, namely workplace wellness, wellness coaching and wellness tourism.4.1Workplace wellnessWellness found its place in the corporate world at the end of the 70 s, when companiesstarted using wellness programs not only to take care of their employees, but also to reducethe costs of health insurance American employers pay for employees (Chapman, 2008).Except for positive outcomes of such programs, there are as well negative responses, sayingthat workplace programs became a necessary evil for employees and a duty for employers –81% of American businesses with 50 or more employees have some form of wellnessprogram (Ardell, n.d.b). Majority of programs focus on reducing health risks and countingROIs while the holistic perspective on employees health is usually left out. Yet there areauthors and companies who go deeper under the surface and perceive health and productivityof employees as a part of overall culture of given organization (see for example Allen (2008).4.2Wellness coachingThe principle of wellness coaching was set by John Travis in his Wellness ResourceCenter: “It's essentially that we're not diagnosing, treating, or taking care of the person. We'reserving as a consultant, to give them more information, teach them skills, to show them howto become more aware of their past, to see what's going on inside their bodies, how tovisualize, how to communicate better, how to love and accept themselves“. (Travis &Ferguson, 1978) This approach combines life coaching with principles of wellness and on aplatform of individual and group sessions helps clients to discover and use their own abilitiesand resources that are necessary for lasting life-style change (Arloski, 2007).

4.3Wellness tourismDespite the fact that wellness movement in United States is not as common in thecontext of spa industry as in Europe, the trend of wellness tourism is global and it isappropriate to mention it here.Stanford Research Institute (2010) in a report Spas and the global Wellness market:Synergies and Opportunities estimated that the wellness industry to be of nearly 2 trillion USdollars globally and in recent report The Global Wellness Tourism Economy (SRI, 2013)estimates the size of wellness segment of the global tourism industry to be 439 billion USdollars. There are more authors who see wellness as a gold-mine of these days (see forexample Pilzer (2007).Obrázek 4: The Wellness Tourism (SRI, 2013)Traditional spa services as well as wellness tourism have their place in this new risingglobal wellness industry, but foremost “spa leaders [should] refine and expand their vision ofwhat wellness really is. [ ] There are many reasons for spas to take a leadership role inREAL wellness promotion, besides the obvious fact that there is money to be made fromdoing so” (Ardell, 2010).5 Conclusion about the starting point for Czech wellnessWellness in Czech Republic follows the trend of above mentioned wellness tourismand is tied to the context of spa resorts and wellness centers. There is a connection betweenspa services and the concept of wellness, but it is not as strong as many Czechs might think.Former concepts of wellness don’t locate wellness to a concrete place but aim to applythe principles of wellness into daily life. This “American” wellness gives the responsibility

for one’s health and quality of life into the hands of every person, excluding the authority of a“medical professional” who knows what to do in every situation of one’s life. Instead,“wellness professionals” bring forward many options; encourage trying it out and serving as asource of information and motivation, especially in the moment when former determination tochange one’s life is gone.For healthy expansion of the wellness industry, not only in Czech Republic, it isnecessary to know the origins of wellness as foreign model of holistic health; and being awareof its beginnings, cultural aspects and specifics of its evolution in the United States. We can’tuse the word wellness just for of its marketing potential. Specifically the knowledge of formerconcepts of wellness and its current applications can serve as a good source of inspirationwhen strategically planning the development of Czech spa industry, brainstorming newservices for existing wellness centers or educating staff of those facilities.6 ResourcesAllen, J. (2008). Wellness leadership: creating a supportive work environment forhealthier land more productive employees. Burlington, Vt.: Human Resources Institute, LLC.Ardell, D. B. (n.d.a). Wellness: Basic definitions of wellness.é z is wellness.htmArdell, D. B. (n.d.b). Workplace Wellness. The Complete Business l, D. B. (1977). High level wellness: an alternative to doctors, drugs, anddisease. Emmaus, PA: Rodale Press.Ardell, D. B. (2004). What Does Wellness Mean? A Schism in the Field Leads to s/2004-02-10.htmArdell, D. B. (2010). European Spas Poised To Become Change Agents for 06-08.htmArloski, M. (2007). Wellness coaching for lasting lifestyle change. Duluth, Minn.:Whole Person Associates.Cohen, M. (2010). Wellness and the Thermodynamics of a Healthy Lifestyle. AsiaPacific Journal of Health, Sport and Physical Education, 1(2), 5–12.

Corbin, C. B., & Pangrazi, R. P. (2001). Toward a uniform definition of wellness : acommentary. Research digest - President’s Council on Physical Fitness and Sports (U. S.).Dostupné z, H. L. (1959). High-Level Wellness for Man and Society. American Journal ofPublic Health and the Nations Health, 49(6), 786–792.Healthy People. (1979). Healthy People: The Surgeon General’s Report on HealthPromotion and Disease Prevention. Dostupné z, L. S. (2008). Planning wellness: getting off to a good start. Seattle, Wash.:Chapman Institute.Miller, G., & Foster, L. T. (2010). Critical synthesis of wellness literature. Dostupné z, J. W. (2005). Wellness: The History and Development of a Concept. SpektrumFreizeit, 2005(1), 84–106.Monroe, M. (2006). What is wellness? IDEA Fitness Journal, (September).Pilzer, P. Z. (2007). The wellness revolution: how to make a fortune in the next trilliondollar industry. Hoboken, N.J.; Chichester: Wiley ; John Wiley [distributor].Poděbradský, J. (2008). Wellness v ČR. Ministerstvo pro místní rozvoj ČR. Dostupnéz -0784086ae3e5/GetFile 4.pdfSRI, Stanford Research Institute. (2010). Spas and the Global Wellness /images/stories/pdf/gss sri spasandwellnessreport rev 82010.pdfSRI, Stanford Research Institute. (2013). The Global Wellness Tourism r, J. (2010). A Brief History of Wellness. Wellness Inventory Travis, J. W., & Callander, M. G. (1990). Wellness for Helping Professionals:Creating Compassionate Culture. Wellness Assoc.Travis, J. W., & Ferguson, T. (1978). How Health Workers Can Promote Self-Care.Dostupné z 252

Travis, J. W., & Ryan, R. S. (2004). Wellness workbook: How to achieve enduringhealth and vitality. Berkeley: Celestial Arts.7 Contact informationMgr. Jana Staráprof. PhDr. Michal Charvát, CSc.Faculty of Sports Studies, Masaryk UniversityKamenice 5, 625 00 Brno,Czech RepublicEmail: [email protected]

WELLNESS: ITS ORIGINS, THEORIES AND CURRENT APPLICATIONS IN THE UNITED STATES . Jana Stará, Michal Charvát . Abstract: In the Czech setting, wellness is known as a synonym of spa facilities, but the former concept of wellness, as it