Americans consistently report living with a level of stress that is higher than what they believe is healthy, and as many as one in five Americans report suffering from an “extreme” level of stress as measured on a 10-point scale. However, most Americans report that they do not receive support from health care providers that could help them manage their stress and make lifestyle and behavior changes.
Chronic stress can have negative impacts on mental and physical health. When life stressors—such as negative events, chronic strains, and traumas—are measured comprehensively, their damaging impacts on physical and mental health are substantial. Furthermore, research indicates that one of the primary ways in which health disparities among different socioeconomic groups are created and perpetuated is through differential exposure to stressful experiences.
The U.S. Department of Health and Human Services’ Healthy People 2020 initiatives recognize that mental health and physical health are closely connected. Psychosocial stress contributes to adverse mental and physical health effects including “anxiety, depression, inflammation, increased blood pressure, rapid breathing, and the increased release of cortisol and epinephrine”—all of which may play an important role in chronic disease development. Chronic stress may also be indirectly related to a number of health conditions through stress-related behavioral changes. People are less likely to make healthy choices when chronically stressed. Chronic stress may lead to increases in risky health behaviors such as poor diet, decreases in physical activity, increases in alcohol consumption, and increases in tobacco and other substance use. Stress management and reduction programs may assist in preventing chronic diseases and could play a larger role in preventive public health policy, particularly in communities that experience more adverse health impacts from stress.
Meditation and other mind-body techniques have the potential to reduce stress and to improve health outcomes. Mindfulness-Based Stress Reduction (MBSR) is a form of integrative therapy that has been demonstrated to help people manage stress and to adapt to chronic illness. MBSR combines mindfulness mediation and yoga into a structured clinical program which focuses on cultivating an enhanced moment-to-moment nonjudgmental awareness of experience. Research suggests that MBSR may be effective in improving health outcomes for a range of mental and physical conditions, such as depression, anxiety, substance abuse, eating disorders and binge eating, insomnia, chronic pain, attention-deficit/hyperactivity disorder, HIV, cancer, and heart disease. Furthermore, MBSR has been recognized by the Substance Abuse and Mental Health Services Administration (SAMHSA) as an evidenced based program through the National Registry of Evidence-based Programs and Practices (NREPP).
Such stress management and reduction programs are gaining increasing recognition and are being incorporated into wellness programs. While MBSR is generally not eligible for insurance coverage, some insurance plans have integrated MBSR into their wellness programs. For example, under the University of Minnesota’s workplace wellness program, employees participating in a MBSR program may be reimbursed for part of the cost of the program or may earn wellness points to reduce their medical plan rate.
As these programs become more prevalent, legal issues relating to possible reimbursement of complementary and integrative medical therapies and the integration of MBSR and other mind-body approaches into workplace wellness programs will need to be considered. In addition, legal issues relating to the credentialing and licensing of complementary care providers may become more prominent as well.
Research on the public health impacts of MBSR and other mind-body approaches is currently underway. The Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School has established the first international registry designed to compile and analyze MBSR data through a public and population health perspective. A number of studies have already demonstrated the potential of mind-body interventions to prevent or reduce health disparities among various socioeconomic populations.
Given their demonstrated positive health benefits, stress management and reduction programs may play an increasingly prominent role in our health care system. The Network will continue to examine laws and policies related to the programs as they develop. If you are working on these issues and would benefit from legal technical assistance, please let us know.
This blog post was developed by Brittney Crock Bauerly, J.D., Staff Attorney for the Network for Public Health Law–Northern Region.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this post does not constitute legal advice or legal representation. For legal advice, readers should consult an attorney in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.