INTRODUCTION

Healthcare systems globally face critical challenges. The United States spends more per capita on healthcare than any industrialized nation yet produces some of the poorest health outcomes.1–3 Chronic conditions such as cardiovascular disease, diabetes, and musculoskeletal disorders consume a large portion of healthcare expenditures, while prevention and upstream interventions remain underfunded.4 Despite repeated reforms, most interventions fail to alter the underlying goal of the system: reactive, volume-driven, fee-for-service care.5

This paper argues that embedding Whole Health into chiropractic colleges by shifting goals, incentives, curricula, and narratives can prepare future healthcare practitioners for person-centered, equitable care; I apply NASEM, Meadows, and CaseMaking™ to propose a practical roadmap.

The paper proceeds in 6 steps: first outlining the global problem of reactive care and poor outcomes; second, introducing conceptual frameworks (Whole Health, NASEM, Meadows, and CaseMaking™); third, analyzing barriers; fourth, proposing transformational strategies; fifth, illustrating application through the SCU case; and finally, concluding with implications for chiropractic education worldwide.

DISCUSSION

Whole Health as a National Priority

In 2023, the National Academies of Sciences, Engineering, and Medicine (NASEM) released Achieving Whole Health: A New Approach for Veterans and the Nation. The report highlighted the success of Whole Health programs within the U.S. Department of Veteran Health Affairs (VHA), where shifting care delivery toward mission, aspiration, and purpose (MAP) produced measurable improvements in patient satisfaction, opioid reduction, and healthcare utilization.6 Specific results included:

  • A 38% decrease in opioid use among veterans who used comprehensive Whole Health services vs ~11% decrease among those who did not

  • Veterans also reported improvements in patient-centered care, engagement in health, self-care, perceived stress, and MAP.

  • Use of Whole Health services is associated with smaller increases in outpatient pharmacy costs among veterans with mental health conditions (3.5% vs ~12.5%) compared to non-users.

The outcomes of the VHA show that Whole Health is a proven concept and the NASEM report called for the scaling and spreading of the concept across national health systems, naming health professions education as a key lever for systemic change. Whole Health, as defined by NASEM (2023), emphasizes care that is people-centered, comprehensive, upstream, equitable, and team-focused. Cornerstone Collaboration delves deeper defining it as “Living a full and meaningful life, empowered and equipped to address all aspects of well-being – mental, physical, and spiritual. Whole Health transformation requires cultural change, not just clinical change” (T. Gaudet, personal communication, September 28, 2025). Whole Health focuses on the whole person and asks individuals not, “What’s the matter with you?” but rather, “What matters to you?”7 This shift from pathology to purpose defines Whole Health’s transformational potential for education and practice.

Cornerstone cites 3 core functions:

  • Empower (focusing on meaning and purpose creates intrinsic motivation)

  • Equip (skill building and support addresses self-care and behavior change)

  • Treat (holistic clinical care aligns with the person’s purpose)

They also emphasize "the Locus of Control – from medicalized to humanized. Shifting from a reactive, expert model to a proactive one, aligning with what matters most to the person and where they want to start. Based in communities, not clinics, drawing on local culture and resources (T. Gaudet, personal communication, September 28, 2025).

The Chiropractic Context

Chiropractic education traditionally emphasizes non-pharmacologic interventions, musculoskeletal function, and preventive care. These elements align naturally with Whole Health’s emphasis on proactive, person-centered care. However, only a small fraction of chiropractic colleges explicitly integrate Whole Health into their curricula or institutional missions. This gap represents both a challenge and an opportunity for leadership.

Systems Change in Health Professions Education

Efforts to reform health professions education often fail because they target surface-level processes (e.g., adding courses, adjusting payment structures) without addressing deeper structural or cultural forces. Donella Meadows articulated a hierarchy of “leverage points” in systems, ranging from shallow (parameters, buffers, feedback delays) to deep (paradigms, goals, mindsets). True transformation occurs only when the purpose and mental models of a system are altered.

In chiropractic colleges, the dominant paradigm remains disease-focused, reactive, and siloed, despite historical roots in holistic practice. Changing this requires altering institutional goals, faculty incentives, curricula, and narratives.

Moral Imperatives in Health: Berwick’s Perspective

Donald Berwick expands the argument for Whole Health by grounding it in moral responsibility.8 In The Moral Determinants of Health, Berwick contends that health professionals are obligated not only to treat illness but also to address structural and social injustices such as poverty, inequality, and climate threats that undermine well-being. He calls for a “moral law of solidarity,” urging healthcare leaders to recognize that advancing justice and community well-being is central to their professional role. This framing elevates Whole Health from a clinical model to a moral imperative, reinforcing the ethical duty of chiropractic education to orient toward equity, social determinants, and societal well-being.

Cultural Transformation for Whole Health: Lessons from Gaudet

Tracy Gaudet, champion of Whole Health implementation efforts, highlights that sustainable adoption requires cultural transformation.9 In her article Cultural Transformation to a Whole Health System: Lessons Learned, she argues that Whole Health cannot succeed through incremental improvement alone. Instead, transformation requires changing the very purpose of healthcare—from managing disease to cultivating well-being—and aligning multiple societal systems to support that purpose. Gaudet emphasizes that institutions must confront and shift their underlying culture, mindsets, and reward structures if Whole Health is to become embedded and enduring.

Synthesis with Existing Frameworks

Together, Berwick’s moral call and Gaudet’s cultural insights reinforce the need for deep educational transformation. Berwick situates Whole Health within the ethical domain of justice, while Gaudet demonstrates that success depends on shifting institutional and societal culture. Their perspectives complement the NASEM framework and Meadows’ systems theory, highlighting that chiropractic education must be ethically grounded and systemically transformative. Incremental or surface-level reforms will be insufficient; instead, chiropractic colleges must embrace Whole Health as both a professional responsibility and a cultural mission.

Methods / Conceptual Frameworks

This analysis integrates 4 complementary frameworks:

  1. Whole Health (NASEM; Cornerstone Collaboration): Defined above. Whole Health transitions the purpose of healthcare to optimize health and healing so that people can live their most meaningful lives.

  2. NASEM Whole Health Educational Model: Identifies 5 foundational elements of Whole Health: people-centered care, holistic approaches, upstream focus, equity, and team well-being.

  3. Meadows’ Systems Change Framework: Provides a roadmap of leverage points to prioritize deep interventions at the level of goals, rules, and paradigms.

  4. Manuel’s CaseMaking™ Principles10: Offers ten leadership principles to align stakeholders, build coalitions, and sustain narrative momentum.

RESULTS/DISCUSSION

Why Chiropractic Colleges?

Chiropractic institutions are natural incubators for Whole Health because of their alignment with prevention, function, and patient empowerment. Additionally, chiropractic’s marginalization from mainstream healthcare has fostered an identity that values alternative paradigms making the profession potentially more open to Whole Health principles. However, to move from potential to leadership, chiropractic colleges must undergo deliberate and systemic transformation.

Barriers to Implementation

Those looking to transform health care towards Whole Health are certain to face barriers to the status quo. Drawing again on Meadows, barriers can be categorized by leverage point:

Paradigm-level: Persistence of a biomedical identity within curricula.

Goals: Institutional missions focused on producing clinically competent practitioners rather than holistic health leaders.

Structures: Tenure and promotion criteria undervalue interprofessional collaboration and alignment with whole health principles.

Information: Lack of outcome metrics on well-being, purpose, and equity.

Transformational Strategies

Reframing Institutional Goals

Chiropractic colleges must rearticulate their missions from “graduating competent chiropractors” to “graduating Whole Health clinicians who improve population well-being and equity.” Embedding this reorientation into accreditation self-studies, strategic plans, program learning outcomes, and governance structures signals a deep shift in system purpose.

Aligning Faculty Incentives

Faculty workload, tenure, and promotion must reward interprofessional teaching, Whole Health research, and community engagement. Without altering incentives, efforts at curricular change will be undermined by competing demands.

Curriculum Reform

Whole Health integration requires more than adding electives. Foundational modules should include:

  • Meaning and purpose in health,11

  • Social determinants of health and equity,

  • Interprofessional teamwork and communication,

  • Reflective practice and clinician well-being.

Clinical training must incorporate Objective Structured Clinical Examinations (OSCE) that simulate Whole Health team encounters, requiring students to co-create care plans with patients based on MAP and social context.

Information Flows and Measurement

Colleges should develop dashboards to track:

  • Patient-reported outcomes (function, satisfaction, purpose-concordant goals),

  • Student and faculty well-being,

  • Equity metrics (closing gaps in access and outcomes).

Feedback Loops

Feedback loops are essential not only for initiating transformation but also for sustaining it. In chiropractic colleges, outcomes should be tracked at multiple levels:

  • Learners: OSCE performance on MAP-aligned care planning, teamwork ratings, reflective practice rubrics.

  • Patients in teaching clinics: Patient-Reported Outcomes Measurement Information System (PROMIS) global health, functional status, pain interference, and purpose-concordant goal attainment.

  • Equity: Outcomes stratified by language, race/ethnicity, gender, and socioeconomic status.

  • Faculty: Burnout assessed by the Mini-Z (a brief and validated questionnaire used to measure and understand the sources of burnout, stress, and job satisfaction among healthcare professionals), engagement, and outputs in interprofessional/Whole Health scholarship.

  • Programs: Graduate practice patterns (use of Patient Reported Outcome Measures – PROMs), team-based care, licensure results, board performance.

These measures establish reinforcing feedback loops that celebrate success, detect drift, and sustain momentum.

Situating Whole Health Among Comparators

Whole Health differs from earlier models such as the biopsychosocial model, the Patient-Centered Medical Home (PCMH), or the Chronic Care Model. While those frameworks expanded care beyond biomedicine, Whole Health uniquely centers MAP, elevates patient empowerment, and requires cultural transformation of institutions and communities. This distinctiveness helps preempt pushback that “we already do this,” clarifying Whole Health as an evolution, not a duplication.

CaseMaking™ in Action

Manuel’s CaseMaking™ framework provides a practical set of tools to translate Whole Health ideals into action. The 10 principles serve as both a diagnostic lens and a leadership playbook; when applied to chiropractic colleges, they guide how to move from abstract aspiration to concrete institutional change.

Applying Manuel’s principles, chiropractic colleges can:

  • Connect to aspirations: Show students and faculty that Whole Health restores chiropractic’s holistic identity.

  • Name the cost of inaction: Demonstrate that failure to adapt risks irrelevance in an outcomes-based system.

  • Reframe narratives: Counter the perception that Whole Health dilutes chiropractic skills by showing how it expands scope and relevance.

  • Empower stakeholders: Position students, faculty, and patients as co-creators of transformation.

A recent example illustrates the principle that Whole Health “works”: in 2024, Southern California University of Health Sciences (SCU) became the first institution designated as a Whole Health University. This milestone reflects both faculty and student mobilization and provides a living case that Whole Health is more than a concept and exemplifies how a legacy chiropractic institution (Los Angeles Chiropractic College, LACC) can transform its culture and identity around purpose-driven, interprofessional care. It is a model that can be implemented and celebrated. In addition to SCU’s commitment to embedding Whole Health across teaching, faculty well-being, and clinical practice they also launched a Doctor of Whole Health Leadership program, the first and only of its kind, designed for working health care professionals who are passionate about transforming health care towards Whole Health. SCU also partnered with the Academy of Integrative Health and Medicine (AIHM) and the Cornerstone Collaboration for Societal Change to host the Whole Health Conference – “Bringing Whole Health to Life” in San Diego Oct 2024.

While outcomes are early, SCU provides proof-of-concept for the chiropractic profession globally in “calling for radical transformation and movement to a more effective, affordable, humane approach – a Whole Health approach”.12 In this emerging field much work remains in developing outcome measures to determine if improvements are made in the health of the whole person.13 While full adoption across all chiropractic programs may be aspirational, introducing Whole Health principles within diverse institutional contexts can catalyze alignment around shared values of prevention, equity, and purpose-driven care.

CONCLUSION

Chiropractic colleges worldwide have a historic opportunity to lead healthcare transformation. By embedding Whole Health principles, leveraging systems change strategies, and applying narrative leadership, institutions can prepare graduates who promote well-being, prevention, and equity. The chiropractic profession can thus reclaim its holistic heritage while positioning itself as an innovator and leader in global health reform.

Disclaimer

The views and opinions expressed in this manuscript are those of the author and do not necessarily reflect the official policy or position of Southern California University of Health Sciences.

Conflict of Interest

The author declares no conflicts of interest related to the content of this manuscript.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.