Approaches to Holistic Health: Bali and the United States
Written by Vivian Phan
Trigger Warning: Brief mentions of systemic medical abuse, mental illness, and police violence.
Holistic healthcare is defined as an approach to wellness that considers the multidimensional aspects of life. It encourages the provider to recognize the whole person, which includes taking into account their social, spiritual, emotional, environmental, physical, financial, intellectual, and occupational well-being (1). There are many interpretations of holistic healthcare across the globe and the importance placed on each factor differs from place to place. As someone born and raised in the United States, I believe the US values and prioritizes the physical aspects of healthcare. However, the mental, social, and intellectual parts also play a role. In fact, Google Researcher Alana L. Conner conducted a study of over 334 men and women from various socioeconomic backgrounds in the US and found that 45.8% of participants view health simply in terms of illness-based diseases and disregard many of the other contributing factors (2). During my time studying abroad in Bali in 2022 I was able to compare my observations of the US approach to the Balinese healthcare system and observe the cultural integration of both spiritually influenced and natural remedies (3).
There are many different descriptions of the many components of wellness, but the above eight represent an encompassing list of areas of fulfillment that contribute to the overall wellness of an individual.
This is a view of the Tegallalang Rice Terrace, open for visit to tourists. Rice is a fundamental part of the Balinese diet and has been cultivated in Indonesia for thousands of years (Jl. Raya Tegallalang, Tegallalang, Kec. Tegallalang, Kabupaten Gianyar, Bali 80561, Indonesia).
Most diseases in the US are treated with medication. While there are preventative services, the medical factor of health is the main focus (4). Additionally, access to services is largely dependent on socioeconomic status, location, and whether or not someone has health insurance. There has been a growing shift towards holistic services because there are many conditions that are not currently treatable by medications. For those who cannot identify holistic care when faced with ongoing health problems, many seek either remedies through a Google search, or continue to seek medicine from physicians (4). Those who lack access to care suffer most which is exacerbated by an ever-increasing wealth disparity (2). The Health Inequality Research Project found a significant correlation between wealth and life expectancy. It found that wealth increased life expectancy in men by 15 years compared to men living in poverty conditions and that the life expectancy for healthy women was 10 years longer compared to women living in poverty. This trend has not plateaued, but a notable limitation is that non-cis-gendered individuals were not assessed in the study (5).
A key issue with holistic healthcare in the US is that most of the research conducted on health has been focused on people’s thoughts about illness instead of the mindset surrounding holistic and preventative care. Understanding this mindset can provide the groundwork for interpreting and responding to health information, which ultimately helps tailor treatments (2). Furthermore, there is a lack of research in the US that includes non-white individuals and individuals from diverse socioeconomic and ethnic populations. Studies of those in the US have shown those originating from a middle-class European culture tend to think about health as an individualistic and independent endeavor, whereas both people of color, and those with low socioeconomic income each tend to associate health with interdependence or the connection to a divine or spiritual being (2).
These differences in cultural mindset became very apparent during my travels. I visited Bali in the summer of 2022 as a part of two University of California San Diego global health courses on medicine, healing, and community development within Balinese society. I stayed in a rural village and spent time with many Balinese people and explored their healthcare practices through visiting their midwifery, HIV/AIDs Center, and Women’s Empowerment Center. This opportunity allowed me to immerse within the welcoming Balinese culture where I learned a great deal about their healthcare structures and philosophies.
In comparison to the average US resident, Balinese people are highly spiritual and their spirituality is heavily associated with their environment. Moreover, in Indonesian culture, one’s spirituality is often translated into one’s approach towards healthcare. In fact, while the law has become more relaxed since 2017, it was previously required of Indonesian citizens to identify with one of the country’s six main religions on their national ID card rather than allowing citizens to list their own faiths (6).
A traditional healer explained to me that Balinese holistic healthcare is based on the Ayurvedic belief stating that humans are made up of three components: physical, metaphysical, and the soul (3). Health and wellness are based on a balanced system and the main goal of this belief is to promote health instead of treating disease (7). In addition, it is believed that foods fall under various categories as a means of promoting balance. If one consumes too much of one type, these Balinese beliefs suggests they eat the opposite kind for harmony within their bodies (3). For example, it is believed that if someone is feeling overheated, they can balance this by eating cold foods, such as cucumbers. Additionally, when Balinese people seek holistic healthcare, they have the option of going to a doctor or a bailan. A balian is an individual who is believed to possess spiritual power and utilizes naturally grown ingredients to treat illness (7). Personally, I appreciate the option to seek different types of healthcare because the experience of healthcare varies for each individual and a practice may better suit one person compared to another to address their personal goals.
Vivian and her peers touring an IDEAP Foundation sustainable garden, which focuses on creating sustainable farming practices to grow fruits and vegetables that can be implemented in other villages to improve access to healthy foods in communities where traveling to marketplaces for fresh groceries is not always an option, as well as reduce the environmental impacts of transporting produce and the inevitable accompanying waste.
While at a rural village in Bali, I accompanied children five and older on an herbal plant walk where they were able to identify plants and their medicinal uses (3). With the nearest doctor a forty-five minute drive away, the community’s resourceful use of plants and guidance from the local bailans offered much needed support during minor health issues. However, those who lived within cities shared with me that their proximity makes it more common to see a doctor. Similarly to the US, there is a clear association with an individual’s location and the culture they experience surrounding healthcare (3).
Understanding the significance of cultural practices and traditions is crucial in addressing health imbalances. As a child, when I was faced with a health problem, my parents first instinct was to take me to a doctor. In Bali, depending on where they are located and their beliefs, Balinese people may consider going to a bailan first or trying to cure the problem themselves, leaning into spiritual and herbal guidance. If the problem persists, then they would try to seek a physician, but access can be scarce. The outcomes for mortality in these smaller communities have not yet been thoroughly studied. Again, the nearest doctor in the rural village where I stayed was a forty-five minute drive away, which inherently presents a significant physical barrier for those who need access to care, especially in an emergency.
There are some evident similarities between the holistic healthcare practices in the US and Bali. While there is progress being made in both places, addressing mental health is still considered taboo in both cultures and is often pushed aside. In the US, mental health disorders are often considered criminalized, with 25% of police shootings in 2015 concerning those facing a mental health crisis despite evidence indicating that those facing mental health crises are unlikely to be at an increased threat for violence to the public (13; 15). Many individuals in mental health crises also report they feel stigmatized after interactions with the police (13).
There is a possibility that the increase of holistic healthcare may be connected to the growing distrust in a healthcare system that has failed many. Minority populations in the US are particularly impacted by the shortage of providers in the US combined with systemic racism within the medical filed, ultimately leading to unequal health coverage (4). According to the Federal Health Program for American Indians, the Indigenous community in the US have been subject to reduced health status and disparities compared to all other Americans (14). The Indigenous population has a life expectancy of 5.5 years fewer than all others living within the US and experience higher rates of mortality in many medical categories, partially due to justified mistrust in the healthcare system after systemic medical abuse, often worsened by financial hardships and challenging social conditions (14). Furthermore, being able to financially afford seeing a doctor is a struggle across all of the United States as well as Bali, which may also be tied to the rising interest in holistic remedies.
In both systems, there is an emphasis on the power of individual choice and the ability to seek care from any preferred caregiver. Therefore, it is important to know that there is no one “correct” system because healthcare is applied differently for everybody, but that the expertise of a licensed medical professional should always be considered before altering a medical treatment plan or adjusting medication regimens. Additionally, in both societies, medications are still one of the common outcomes after a visit to a health practitioner. However, I noticed that in Bali, meditation and prayers to various deities for a faster return to health is often classified as a form of medication by their providers, emphasizing their focus on spirituality.
There has been limited research to study and validate these practices in showing the effectiveness of Balinese holistic remedies. More research must be conducted before a conclusion about any benefits of the herbal remedies themselves can be derived. However, one study researched the ingredients in a traditional remedy, lolah, and found that the use of medicinal plants has played a role in educating the community on plant cultivation (8). In fact, a study among older adults concluded that using integrative medicine, which includes herbal medicines, to be less invasive, more cost friendly and culturally acceptable as treatment (9). Examining the overall use of herbal remedies for treatment, there are a few points of concern. First, the suggested dosages of the herb to reach the claimed effect usually have little supporting research, and on top of that, using herbal remedies in combination with other over-the-counter or prescribed medications can dramatically increase side effects (10). For instance, in a study analyzing forty-nine individual case reports, from the British Journal of Clinical Pharmacology, it was found that herbs such as sage and flaxseed can interact with cardiovascular drugs and cause bleeding (11). When depression levels were found to increase among those using drugs for menopause, herb-drug interactions, such as the combination of the drug with the herbal supplement Mentat, was concluded to be the likely cause in 51% of the reported cases (11). Moreover, herbal formulations are not controlled for quality or safety like prescription medication and most remedies remain unvalidated. The use of herbal remedies frequently concerns the use of multiple ingredients, which can enhance potential side effects (10). In fact, nine in ten health food stores in the US recommend dietary supplements to help with treating illness, but there is limited evidence for their efficiency and around one third of calls to poison control centers pertain towards unintended symptoms of taking these supplements (12). Overall, the choice of using herbal remedies lies with the individual, but the importance of understanding the risk of consuming any supplement or medication without first having it reviewed by a licensed physician cannot be overstated.
Different approaches to treatment emphasize the diversity of cultural understanding of wellness. Holistic health includes diet, spirituality, the environment, doctor visits, and taking medicine; wellness and medicine are utilized simultaneously. Holistic healthcare is extremely valuable because it addresses the causes of health issues instead of solely the physical symptoms. This enables individuals to be proactive about their well-being. Medicine should not be considered bad, but should adapt to include more practices connecting to the emotional and spiritual aspects of health. It is important to consider the pros and cons in both practices and work to integrate them into a more sustainable practice. Health needs around the world are constantly changing and integrating adaptability into a flexible system is important to address health disparities for those with the least access to care.
Vivian and her friend, Amy, show off the handmade bags purchased from a local artisan at the marketplace in Ubud, Bali.
About the Author:
Vivian is currently a senior at University of California San Diego and is majoring in Human Biology and minoring in Global Health. She is interested in pursuing a career as a genetic counselor and is passionate about expanding healthcare services in underserved communities. In her free time, she likes to play tennis, hike, and watch sunsets.
Sources:
Search WCSU. Institute for Holistic Health Studies. (n.d.). https://www.wcsu.edu/ihhs/what-is-holistic-health/#:~:text=Holistic%20health%20is%20an%20approach,social%2C%20intellectual%2C%20and%20spiritual
Conner, A. L. (2018). Americans’ health mindsets: Content, cultural patterning, and associations with physical and mental health. Annals of Behavioral Medicine, 53(4), 321–332. https://doi.org/10.1093/abm/kay041
Vivian Phan, UCSD Health, Healing and Sustainable Community Development in Bali Global Seminar 2022
Woolf , S. H. (2013). 4 public health and Medical Care Systems - NCBI Bookshelf. U.S. Health in International Perspective: Shorter Lives, Poorer Health. https://www.ncbi.nlm.nih.gov/books/NBK154484/
Reddy, M. R. (2021, June 30). 5 Reasons to be Cautious When Considering Herbal Remedies. Penn Medicine Lancaster General Health. https://www.lancastergeneralhealth.org/health-hub-home/2021/june/5-reasons-to-be-cautious-when-considering-herbal-remedies
Nguyen, G. (2019, October 25). Indonesian law requiring citizens to identify with 1 of 6 religions is overturned. World Religion News. https://www.worldreligionnews.com/religion-news/indonesian-law-requiring-citizens-identify-1-6-religions-overturned/
Khan , U. (2010, December 24). Healers and hospitals: A story of healthcare in Bali. The Yale Globalist. https://globalist.yale.edu/in-the-magazine/theme/healers-and-hospitals-a-story-of-healthcare-in-bali/
Rasna, I. W., & Tantra, D. K. (2017). Medical plants in USADHA: loloh as Balinese medicine and traditional herbal product in educational perspective. Proceedings of the 2nd International Conference on Innovative Research Across Disciplines (ICIRAD 2017). https://doi.org/10.2991/icirad-17.2017.36
Nguyen, S. A., Oughli, H. A., & Lavretsky, H. (2022). Complementary and Integrative Medicine for Neurocognitive Disorders and Caregiver Health. Current psychiatry reports, 24(9), 469–480. https://doi.org/10.1007/s11920-022-01355-y
Reuell, P. (2016, April 11). For life expectancy, money matters
https://news.harvard.edu/gazette/story/2016/04/for-life-expectancy-money-matters/
Starr R. R. (2015). Too little, too late: ineffective regulation of dietary supplements in the United States. American journal of public health, 105(3), 478–485. https://doi.org/10.2105/AJPH.2014.302348
HealthLine. (2018, January 30). Prescription Drugs, Herbal Products Don’t Mix. Healthline.https://www.healthline.com/health-news/herbal-medications-prescription-drugs-dont-mix
Article Reviewed by: Rachel Baer, MSc, and Andrew J. McCarty, MS, CGC
”Components of Wellness” Infographic: designed by Rachel Baer, original intellectual property of Clover Genetics
Photos of Bali: provided by Vivian Phan, used with permission, taken during summer of 2022