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 evolved in USA in the 70´s, is a holistic model of health
which serves as an alternative to traditional perception of human health. Knowledge of the
origins, former theories and current application of wellness is necessary for healthy
development of this industry, not only in the Czech Republic.
Key words: Wellness, holistic health, workplace wellness, wellness coaching,
wellness tourism.
1 Introduction
A usual question to open this article could be: What is wellness? The term wellness is
very often used by healthcare professionals, as well as by the general public, but usually it
lacks deeper understanding. Absence of generally accepted definition of wellness leads to a
confusion among both professionals and clients and it decelerates the development of a sound
body of scientific knowledge related to wellness. At the same time, the deficiency of clear
explanation 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 wellness
literature” (2010) confirm that those terms are being used interchangeably. We can also find
simplistic explanations of the evolution of the term wellness, such as connecting words well-
being and fitness (Poděbradský, 2008), where the loose translation would be “move and be
OK”. There are no evidences of such formation of the word “wellness” in the original
literature, and from its nature, this explanation is far too reductionist. It limits the holistic and
multidimensional concept of wellness to only two dimensions – physical and psychological,
even though models of wellness have several dimensions, according to Stanford Research
Institute (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 to
1654), more importantly, it is necessary to study the origins of the whole concept of wellness.
2 Ancient origins of wellness
Original sources of wellness ideas can be found in deep history, thousands years ago.
Traditional cultures had sophisticated health care systems that respected and aimed for
balance of human body, mind and spirit and perceived human health from its holistic
perspective (Cohen, 2010; Strohecker, 2010).
Indian Ayurveda, traditional Chinese medicine, or ancient Rome and Greece, who put
foundations for today’s medicine and often to the mentioned ideal of Kalokagathia - these
traditional systems had many aspect in common. Except for curing a disease, they focused on
its 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 the
patient, so different from current medicine.
These traditional healthcare systems emphasized one’s lifestyle – nutrition, physical
activity, quality sleep, moderation, ethical behavior, development of positive thoughts and
emotions 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 wellness
Holistic 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 medicine
was a common practice still in 19
th
century and new therapies like homeopathy, neuropathy,
chiropractic or osteopathy were just developing. However, scientific discoveries of Louis
Pasteur, Robert Koch or Wilhelm Konrad Roentgen moved the modern medicine far ahead.
In the first decades on the 20
th
century, it even seemed that modern science provided
answers 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 from
World Health organization in 1948. The real shift started in late 1960´s, when the modern
medicine neared its limits. Resistant microorganisms were developing more quickly than new
pills and majority of American population was dying on diseases caused not by viruses, but
by people’s lifestyles. It was not enough to change the cure, but also to change to way people
live (Travis & Callander, 1990).
As stated in the official Healthy People: The Surgeon General's Report on Health
Promotion and Disease Prevention (1979):
“The health of the American people has never been better. In this century we have
witnessed a remarkable reduction in the life-threatening infectious and communicable
diseases. Today, seventy-five percent of all deaths in this country are due to degenerative
diseases such as heart disease, stroke and cancer. […] Further improvements in the health of
the American people can and will be achieved – not alone through increased medical care and
greater health expenditures – but through a renewed national commitment to efforts designed
to prevent disease and to promote health” .
The positive definitions of health, the attitude of the World Health Organization
together with official political documents were the first steps ahead. It changed the
perspective from which we perceive human health, and the topic of health promotion and
prevention became usual. However, these official statements and documents are “only”
recommendations and the path to objectively enhanced quality of life of the whole population
was very long.
This was the starting point and the context of rising wellness movement. The concept
of wellness is an application of the positive definition of health, but according to Donald
Ardell ( n.d.), it extends beyond prevention and health promotion. The main goal of
prevention is to avoid illnesses, but wellness aims for a happy, balanced, quality and fulfilled
life. To understand this difference, let’s have a look at former theories of wellness.
3.1 Halbert L Dunn
The 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 of
illness. Except for the fact that the Western world divides men on the physical part that is
cured by doctors, psychological part, cured by psychiatrists, and spiritual part, cured by
priests. 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 on
one’s wellness and quality of his life. Equally important is the person himself, who should
endeavor for personal mastery in all aspects of human life. Dunn’s wellness is about using
options 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 might
have allowed him to see health from far deeper perspective than just fighting diseases. As a
statistician Dunn more intensely reflected the impact of chronic diseases and demographical
changes, 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 of
societal and cultural changes in the second half of the 20
th
century. This era entailed changes
in understanding the role and position of man in the society and in the world. Dunn summed
these changes up as follows: “It is a shrinking world. It is a crowded world. It is an older
world. 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 hold
the 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 illnesses
already in the 50´s. Together with the neurotic and functional diseases, these are very
malicious, because they don’t directly endanger human life, but they have a huge impact on
its quality. Dunn’s ideas were published in 1961 in book High-level wellness, which didn’t get
much echo on the public, but the book found its way to the hands of JohnTravis.
3.2 John Travis – the founding father of wellness
John Travis, a doctor who displeased his role of almighty physician. Inspired by
Dunn´s ideas, contemporary humanistic psychology and many other influences, Travis
launched the very first wellness center in Mill Valley, California. In this center they offered
an eight- months-long wellness program for 1,500 dollars. The program covered weekly
group meetings and individual sessions, and the clients learned how to “relax, experience
themselves, remove barriers, improve communication skills, enhance creativity, envision
desired outcomes, take full responsibility for themselves and love themselves” (Ardell, 1977,
s. 9).
Although Travis focused particularly on wellness in practice, he and his colleagues
have developed a tool to assess one’s levels of wellness (named Wellness Inventory), but
more importantly he has developed theoretical models explaining the links between human
health, 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 mere
absence of illness doesn’t bring wellness, doesn’t mean quality of life, and it is rather a
neutral 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 paradigm
extends over both sides of the continuum. The concept of wellness aims to help people in
achieving higher levels of wellness, more quality lives, no matter what their current state of
physical 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), illustrates
wellness as a practical application of the above mentioned positive definition of health
1
. The
state of physical health at the top reflects Maslow’s principle of interconnectedness between
the dimensions – the tip of the iceberg is a result of fulfilling or suppressing needs on the
lower levels.
Travis’s wellness center together with his clear theoretical concept of wellness created
the foundations for rising wellness movement in the United States. From the unfamiliar word
that was used on the west coast in the 70´s, wellness became a national phenomenon in the
80´s, mostly thanks to the work of Don Ardell.
3.3 Donald B. Ardell – the speaker of wellness
Donald Ardell is the most often heard advocate of wellness thoughts. His dissertation
mapping wellness was published in the 70´s and became a bestseller. Since then Ardell
devoted his life to promoting wellness. His approach to wellness is best described by the
sentence „Wellness Is Too Important To Be Presented Or Lived Grimly“ (Ardell, n.d.a). Don
1
The Iceberg model covered the spiritual dimension of health already in 1978, when it was first
published. The former WHO definition contained only three dimensions – physical, mental and social. The
spiritual dimension was officially added in 1998.
Ardell has gained broad attention for the wellness ideas and up to these days is an active
speaker.
According to Ardell (in Monroe, 2006), “Wellness got stuck in the health field, which
has more of a disease/treatment framework. But wellness could just as well be founded in
psychology, sociology or even public policy. I think it’s often easier for people to think of
wellness in terms of quality existence rather than health.” Except for medicine, Ardell is a
fierce critique of corporate wellness programs, but more on that in chapter 4.1 Workplace
Wellness.
3.4 Bill Hettler – voucher to the academic field and foundation of NWI
The last of the mentioned founders of the wellness movement is Bill Hettler, former
physician at the University of Wisconsin – Stevens Point who created the first faculty wellness
program and introduced the concept of wellness into the academic field. Hettler and his
colleagues founded the National Wellness Institute (NWI) in 1977, a nonprofit organization
that connects and provides further education for health promotion and wellness professionals
and organizes annual international conference.
Wellness in the context of health promotion, prevention and public health became then
a part of university curriculums in the US – for example, the above mentioned university in
Stevens Point offers an online bachelor program, Science in Health and Wellness
Management.
4 Wellness in the 21
st
century
Almost 40 years after its foundation, wellness doesn’t have one broadly accepted
definition and is explained by many people in many ways (Corbin & Pangrazi, 2001). Since
the first wellness center on the west coast, the concept became a part of American and global
culture including professionals, clients and scientists – in scientific databases there are
thousands of records under the term wellness (Miller & Foster, 2010).
Especially in practice, wellness is often simplified and becomes a synonym of
everything that makes one “well and healthy”. There is wellness pet food, wellness fitness
centers and even gardening companies offering “wellness” services. This trend is
international, as in US as in Czech Republic one can buy wellness shower gel or wellness tuna
fish.
Except for this marketing misuse of the term, Don Ardell (2004) defines more deep
distinction 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 antediluvian
and 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 in
life“.
In the midst of these two poles of current wellness movement we can find various
applications of wellness ideas, and in the following chapter we will focus on the most
prevalent, namely workplace wellness, wellness coaching and wellness tourism.
4.1 Workplace wellness
Wellness found its place in the corporate world at the end of the 70´s, when companies
started using wellness programs not only to take care of their employees, but also to reduce
the costs of health insurance American employers pay for employees (Chapman, 2008).
Except for positive outcomes of such programs, there are as well negative responses, saying
that 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 wellness
program (Ardell, n.d.b). Majority of programs focus on reducing health risks and counting
ROIs while the holistic perspective on employees health is usually left out. Yet there are
authors and companies who go deeper under the surface and perceive health and productivity
of employees as a part of overall culture of given organization (see for example Allen (2008).
4.2 Wellness coaching
The principle of wellness coaching was set by John Travis in his Wellness Resource
Center: “It's essentially that we're not diagnosing, treating, or taking care of the person. We're
serving as a consultant, to give them more information, teach them skills, to show them how
to become more aware of their past, to see what's going on inside their bodies, how to
visualize, how to communicate better, how to love and accept themselves“. (Travis &
Ferguson, 1978) This approach combines life coaching with principles of wellness and on a
platform of individual and group sessions helps clients to discover and use their own abilities
and resources that are necessary for lasting life-style change (Arloski, 2007).
4.3 Wellness tourism
Despite the fact that wellness movement in United States is not as common in the
context of spa industry as in Europe, the trend of wellness tourism is global and it is
appropriate 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 US
dollars 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 US
dollars. There are more authors who see wellness as a gold-mine of these days (see for
example Pilzer (2007).
Obrázek 4: The Wellness Tourism (SRI, 2013)
Traditional spa services as well as wellness tourism have their place in this new rising
global wellness industry, but foremost “spa leaders [should] refine and expand their vision of
what wellness really is. […] There are many reasons for spas to take a leadership role in
REAL wellness promotion, besides the obvious fact that there is money to be made from
doing so” (Ardell, 2010).
5 Conclusion about the starting point for Czech wellness
Wellness in Czech Republic follows the trend of above mentioned wellness tourism
and is tied to the context of spa resorts and wellness centers. There is a connection between
spa 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 apply
the 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 a
source of information and motivation, especially in the moment when former determination to
change one’s life is gone.
For healthy expansion of the wellness industry, not only in Czech Republic, it is
necessary to know the origins of wellness as foreign model of holistic health; and being aware
of its beginnings, cultural aspects and specifics of its evolution in the United States. We can’t
use the word wellness just for of its marketing potential. Specifically the knowledge of former
concepts of wellness and its current applications can serve as a good source of inspiration
when strategically planning the development of Czech spa industry, brainstorming new
services for existing wellness centers or educating staff of those facilities.
6 Resources
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7 Contact information
Mgr. Jana Stará
prof. PhDr. Michal Charvát, CSc.
Faculty of Sports Studies, Masaryk University
Kamenice 5, 625 00 Brno,
Czech Republic
Email: jana.stara@mail.muni.cz
