About Kaiser Permanente | Heritage

February 15, 2007

'A Health Plan, not a Sick Plan'

Even 45 years ago, Kaiser Permanente Workers urged to "keep fit" and "eat fruits and vegetables"

"A health plan, not a sick plan."

That's what Sidney R. Garfield, MD, set out to create when he founded Kaiser Permanente more than 60 years ago.

Through the intervening years, Garfield's simple edict has continued to inform and influence an ever-wider range of services, initiatives and innovations at Kaiser Permanente. In fact, Kaiser Permanente has developed a short-hand term for the comprehensive, prevention-oriented services it champions: Total Health.

Total Health's roots were evident in Kaiser Permanente's earliest days. In a 1943 message to employees of Henry J. Kaiser's West Coast shipyards, the organization urged workers to "Keep fit this winter," dress warmly, get plenty of rest and "eat lots of fruits and vegetables."

Medical historian Rickey Hendricks has noted that from the start, KP's Total Health approach emphasized a wellness partnership with plan members.

"Kaiser health planners supported concepts of holistic preventive care," Hendricks wrote in her 1993 book, A Model of National Health Care: The History of Kaiser Permanente. "They wanted subscribers to have the feeling that this plan is their own and that the entire staff are working towards providing them with the best medical attention possible.''

In the San Francisco shipyards, surveys revealed that the majority of workers did not eat an adequate breakfast. As a result, the suggestion was made to develop a hot lunch program and dispense vitamins in order "to bring about greater vitality, greater psychological effect and consequently increased productivity."

Throughout his career, Garfield zeroed in on the concept of Total Health from a variety of perspectives. In the 1960s, he urged KP to embrace the computer, explore the use of nurse practitioners in the delivery of care and make health education far more accessible to members.

Toward the latter objective, Garfield enlisted doctors, health educators, counselors, nurse practitioners and other health professionals in a team effort that focused on ways to deliver patient education as part of the care process.

Today, the educational component of the Total Health philosophy is reflected in a wide range of KP initiatives dealing with everything from disease and weight management to physical education and healthy lifestyle choices.

Replacing the health care system's emphasis on sickness with a focus on health and prevention became truly a life-long mission for Garfield. In 1975, near the end of his remarkable career, the physician spoke to medical students at the University of Southern California about his vision.

"One can envision a new health care system of the future, which will begin with a basic comprehensive health evaluation for each individual," he said. "The result of that evaluation will chart each individual's personal pathway through our health care resources toward optimal health."

Such individualized and seamless health care, Garfield believed, would greatly reduce patient uncertainty and could lead to more efficient use of appropriate resources in ways that optimized the health of each individual through their lifetime.

Physician and author John G. Smillie perhaps best summed up the concept of Total Health in a 1991 book exploring the role KP played in improving health care quality and reducing costs.

"Kaiser Permanente," he wrote, "helped pioneer a shift of consciousness that would become fully evident by the 1980s when health was no longer envisioned as something that doctors gave patients, but as something that healthy members maintained for themselves through a healthy lifestyle."