“Everyone should have access to a health coach.”

When I first thought about this, it felt frivolous and perhaps even privileged. In most contexts, coaches are considered a luxury service, for people who can afford the hefty fees that they charge per hour. But just because something is expensive, doesn’t necessarily mean that it is a luxury. This is especially obvious in healthcare, doctors delivering medical care are not considered a luxury any more than having access to public transport is, even as doctors are considerably more expensive.

Are coaches essential?

This implies that coaches are considered a luxury service not because they’re expensive but because people don’t think of them as essential. And yet, I’d argue they increasingly are.

In our post on the social determinants of healthcare, I explored the myriad of factors that determine an individual’s health outcome. Today, coaches are one of the few professionals who are trained to acknowledge, understand and act on the imperative of holistic, human-centred care that was emphasized in that post.

This is especially relevant to Happily Ever After’s broader vision for preventive care. Coaches play a key role in the high-touch, locally relevant and team-based form of care that is considered the holy trinity of proactively delivered healthcare.

High-touch care

Firstly, health coaches play an important role in delivering high-touch care that encourages long-term behavioural change. This personalized approach to care not only improves individual health experiences but also outcomes, and this is not a novel discovery. Since as far back as 2010, integrated care providers such as Iora Health have placed health coaches front and centre, working closely with individuals to implement lifestyle changes that are tailored to their unique circumstances.

They also go to people’s homes. They can evaluate how the patient is doing, whether their home is safe, if they have food. A lot of times the health coach goes to the grocery store with the patient. They encourage the patient to shop for everything they usually would, and then they’ll look in the cart and help the patient figure out why some of it is a bad idea and what possible substitutes are. Taking patients for walks is something else they do. It’s a really good way to talk about and model exercise behavior.

Rushika Fernandopulle, CEO, Iora Health

Through examples like this, it is obvious that health coaches spend far more time with patients than physicians ever could. And in doing so, they help individuals feel heard and provide a human touch to what is an increasingly transactional medical experience.

Locally-relevant care

Another advantage of health coaches is their ability to provide locally-relevant care that is tailored to specific communities. Unlike physicians who often rely on standard care protocols, coaches can spend more time understanding and improving the social determinants that influence health outcomes in their populations.

This approach not only improves patient outcomes but also helps to build trust and a sense of community within a care group. With the autonomy to communicate and collaboratively problem-solve alongside patients, health coaches are driving a global shift towards patient-centred healthcare.

Team-based care

In addition to the above, team-based care models also improve the division of labour, enabling doctors to focus on diagnosing and treating medical conditions while health coaches focus on helping patients execute lifestyle changes. By working collaboratively, doctors and health coaches can provide a more comprehensive approach to patient care that simultaneously addresses both medical and lifestyle factors that affect individual well-being.

Looking beyond healthcare, coaches can also be equipped to support individuals across different facets of life like jobs, finances and family, which are all interdependent in giving rise to an individual’s sense of holistic well-being.

Still, discourse on coaches is limited, even as preventive care grows in popularity. While the new field of lifestyle medicine is focused on helping doctors understand holistic preventive care, it does little to address existing physician shortages while increasing the burden of responsibility on them. This approach could inadvertently reduce access to healthcare, and distract physicians from their specialized duties of diagnosing, conducting medical procedures, and creating care plans for specific clinical contexts.

Yet many physicians remain reluctant to share responsibility for an individual’s holistic health. This is partly because they derive fulfilment from understanding and managing the full picture of an individual’s health status. Moving the responsibility of regular care away from physicians to coaches, risks eroding the physician-patient relationship and making physicians feel even more detached from the people they serve.

There is also the concern that coaches who are not trained clinically might not have the correct expertise to make decisions, and that clinicians might fall out of the loop of care plans. To me, these seem more like organizational challenges, rather than dealbreakers. Small, lean care teams could streamline communications with the right operational wisdom which should help alleviate many of these concerns. Organizations like Buurtzorg and Iora Health are role models for these kinds of teams.

Pragmatism in Healthcare

I think it’s easy to say things like “doctors should care about a patient’s whole health”, but the practical, on the ground reality makes this infeasible. We simply do not have enough doctors with enough time. If we don’t figure out scalable care models, the people who will be most impacted are ones that can’t access care and likely need the most support for lifestyle modifications.

Nikhil, Out Of Pocket

As Nikhil put it, when weighing the pros and cons of the situation, pragmatism is key. To me, burdening physicians with ever more responsibility comes with a “saviour syndrome” flavour that overemphasizes the role of the individual physician in our health and well-being. In contrast, team-based approaches with an emphasis on coaches spreads responsibility and allow both physician and coach to do what they do best - leading to optimal outcomes for patients.

Coaches also are more affordable and accessible than physicians, and accessibility is critical here. For the global shift to preventive care, we need many more care professionals working to help individuals craft and adopt healthier and happier lifestyles. Having all of these care professionals be physicians, might simply not be financially viable for any healthcare ecosystem.

In any case, one thing is clear. Coaching’s public image as a luxury good must change over the coming years for the shift towards preventive healthcare to succeed. One part of this is improving costs and accessibility while integrating coaches into our health ecosystem. But a large part of it is also education, and teaching people about the importance of coaching for long-term health and well-being.

In short, to substantially move the needle away from reactive forms of healthcare, we must demand universal coaching just as much as we demand universal healthcare.