the role of health coach, agent, navigator, or partner; it could be a primary care provider; or it even might be a medical specialist, depending on the time, the place, and the needs of the individual. The optimizer’s role would be to assure the right intervention at the right place at the right time by the right caregiver at the right value. Johns heard participants talk about the need to localize care, in the home as often as possible, and in the workplace—care should be centralized only when necessary.

Integrative health care is about healthy living, wellness, and prevention, but also, when it is needed, the proper sickness care. Johns reiterated that all these dimensions of care should be based on evidence. However, he recognized that we have to revisit the question of what evidence is and how we determine that the evidence is sufficient to recommend an intervention, therapy, or approach. This requires reinventing the evidentiary model to better assess costs and benefits, said Johns. Based on the value that specific services or approaches provide to the individual and to society, new systems of incentives and rewards can be created.

Last year, the World Health Organization reported on social and behavioral factors in health. Most Americans seem to believe such a report applies only to the developing world, Johns said. However, social determinants of health touch the lives of every American, and communities across the country struggle with poverty, education, and employment. Unless we address these social factors, all of our other efforts will not improve the health of this nation, he said.

Individuals and organizations are inevitably self-centered when it comes to their own interests, he said. This natural tendency may create significant interprofessional friction that could interfere with advancing not only integrative health care as a whole, but also the common goals that have been identified. Summit participants represented a broad mix of interests, people, backgrounds, and personalities, having notable passion, energy, and a great spirit. To ensure the success of integrative health and to overcome the potential for friction, Johns encouraged individuals and organizations to work together and harness the energy and spirit demonstrated at the summit. This may require some groups to become more selfless, and it will require all groups to embrace their unifying interests, he noted. Additional opportunities to come together may help the various professional groups to know and understand each other more deeply.

Next steps, he said, are to circulate the summary of this summit widely and to agree on language and definitions. For example, he suggested replacing integrative medicine with integrative health. Another



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