In This Issue:
BHWP Spotlight
A Study in Wellness
Wellness in Practice:
Awake!
Balancing Acts
In the Flow
BHWP Spotlight
Of the eight dimensions of wellness, environmental wellness is often the hardest to grasp in a tangible way. Definitions of environmental wellness are incredibly varied, personal, and transmutable. Our discussions of this topic draw us into both the sacred and secular. It includes everything from the quality of light in our offices to isolation versus community, the effects of fracking, and how humans fundamentally relate to the world.
Environment is solid yet ephemeral, and as many world religions would tell us—all around us is “maya”, the façade or shroud obscuring eternity. As I ponder environmental wellness, it leads me to questions like “Where do I stop and where does the world around me really begin?” And “Is there a distinction?” The following articles taken together emphasize environment as metaphor, as self, as essential. They speak to the way in which we extend into our surroundings and are equally an extension of our environment. These pieces touch upon how we can shift environment through mind-set, connection, and even public policy.
Years ago, I had the opportunity to teach ecopsychology courses, which focus on many of these themes. One of the most meaningful experiences of my life, I felt deeply connected with the students and community members in my course as we contemplated some of life’s fundamental questions. Environmental wellness brought us together, regardless of religion, political affiliation, or the many other ways we humans excel in differentiating “me” from “you” or “the other.” For just a bit, I hope our offerings unify us in this present moment.
Registration is open for several of our 2019 trainings!
Rocky Mountain Tobacco Treatment Specialist Training Program: May 13 – 16, 2019
Motivational Interviewing for Behavior Change – Level II: August 6 – 7, 2019 (*NEW DATES!*)
A Study in Wellness
Tobacco in Czech Republic:
Notes from the Field
From my first visit in January 2008, Czech Republic has held a special place in my heart and mind. This passion culminated in a Spring 2015 trip for a two-month internship to complete my graduate school program, performing tobacco research for Charles University and the Ministry of Health of Czech Republic. Not to stop there, I married in Prague that summer and honeymooned across the country. While I thoroughly enjoyed all of my time there, tobacco maintained a steady, palpable presence throughout my visits, remaining an unavoidable feature of daily life.
Czech Republic has exhibited high rates of smoking historically. More recently, as of 2016 the nation had the eighth highest per capita consumption of cigarettes in the world and produced a gross national income just a fraction of the six largest tobacco companies.1 For historical context, in the aftermath of the collapse of communism in 1989, the state-owned tobacco industry was overtaken by transnational tobacco companies, which were successful in delaying tobacco control initiatives. The industry even benefited from the support of Czech Republic’s first President and national icon, Vaclav Havel, who was involved in promotional efforts and vetoed progress control bills.2 Clear evidence of past and ongoing tobacco industry influence on tobacco control policies in Czech Republic exists, including measures to circumvent advertising regulations and excise taxes, benefiting from significant political support.3 As the country still lacks national coverage for programs such as a quitline and most pharmacotherapy options for tobacco cessation, the impact of such efforts remains visible.1,4
Czechs remained tolerant of indoor smoking—which was especially pervasive in bars and restaurants—long after most of Europe had already passed comprehensive regulation. However, as of May 31, 2017, Czech Republic formally instituted a nationwide smoking ban in most public places for the first time—a landmark achievement for tobacco control. This past January I returned for my fifth visit to the country in this context, which also happened to be my first visit as a working professional in the field of tobacco control. Although I was primarily visiting as a tourist, I was keenly interested in observing the impact of these recent developments firsthand.
The difference was obvious and immediately apparent. While waiting for access to my Prague rental, I stopped in a restaurant across the street. Amazingly, nobody was smoking inside. Yes, even knowing the new regulations ahead of time, it was truly shocking—the presence of smoke had been that ubiquitous in my past experiences. Adding to my amazement, a few people periodically stepped outside to smoke; I had anticipated that the execution of the ban would be a greater issue in practice. 
This experience repeated itself over the course of my trip, even in some smaller towns outside of Prague. I did notice one or two instances of people smoking from electronic devices indoors, but these appeared to be isolated incidents, and were performed in a discrete fashion.
Aside from my direct observations, I enjoyed an opportunity to dine with tobacco control colleagues from my internship and learn from their insights. For the most part, their reports were reassuring. They said people were generally respecting the national ban, and even more encouraging, that most restaurants and bars were in support of the ban and were seeing positive financial results. (A chief argument of opponents of smoking bans is that they will reduce businesses’ revenue, yet that is rarely the case in practice.5,6) While they mentioned there were some groups pushing for a repeal of the ban, they were generally optimistic that movement would be defeated. Generally, they seemed uplifted to continue their efforts against the tobacco companies and in favor of people seeking to quit smoking.
A final enlightening experience occurred at dinner with Czech friends the following night. Although current smokers themselves, they expressed appreciation for the smoking ban, citing a more pleasant indoor environment and a relative lack of odor on their clothes after going out in public. They even embraced going outside to smoke that night, despite the especially brutal cold. Interestingly, they were also now smoking an electronic device; I had only seen them smoke cigarettes in 2015. Their device of choice was an iQOS product, a Phillip Morris creation that appears to have taken the country by storm—for better or worse—and even has a shiny new store on the main shopping street in Prague. This development presents another interesting scenario that may take on a life of its own, but that’s a discussion for another time.
In reflecting on my recent experience in Czech Republic, my thoughts return to a barrier many organizations in the United States perceive when considering the implementation of tobacco-free policies. Namely, that such policies will face a lack of support and that enforcement will be problematic. Time and again, we find these arguments to be untrue in practice. With that in mind, perhaps the experience of Czech Republic can serve as an inspirational example. If a country with both a long, troubled history of tobacco control and of cultural acceptance of public smoking can make relatively fast, drastic, and effective reforms, what’s stopping smaller organizations?
References:
- Drope J et al. (2018). The Tobacco Atlas, Sixth Edition. Retrieved from https://tobaccoatlas.org/wp-content/uploads/2018/03/TobaccoAtlas_6thEdition_LoRes_Rev0318.pdf
- Zatonski M & Glantz S (2018). Tobacco industry attempts to undermine tobacco control by recruiting Czech and Polish anti-communist dissidents. Tobacco Induced Diseases, 16(Suppl1), A669. https://doi.org/10.18332/tid/84561
- Shirane R et al. (2012). Tobacco industry manipulation of tobacco excise and tobacco advertising policies in the Czech Republic: An analysis of industry documents. PLoS Med, 9(6), e1001248. https://doi.org/10.1371/journal.pmed.1001248
- Karbusicka M et al. (2015). Cost-effectiveness analysis of tobacco dependence treatment in the Czech Republic. Value in Health, 18(7), A502. https://doi.org/10.1016/j.jval.2015.09.1423
- Centers for Disease Control and Prevention [CDC]. (2011). Tobacco use: Targeting the nation’s leading killer. Retrieved from https://stacks.cdc.gov/view/cdc/5527
- United States Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Office of Applied Studies. National Survey on Drug Use and Health, 2003. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2015-11-23. https://doi.org/10.3886/ICPSR04138.v5
Wellness in Practice
Awake!
A few weeks ago, I had an opportunity to take a hike in the mountains just outside of Estes Park, Colorado. While our intention had been to snowshoe, the clear, warm weather and lack of snow disrupted our plans. Going with the flow, we found a nearby trail that carried us up to a stunning landscape of snowcapped peaks. As we neared the top of the mountain, we were brought to a full stop by an amazing view—a large rock with a perfectly round hole in the center of it.
Immediately I was reminded of something I tell myself when I feel the need to use force to dislodge something that feels stuck—situations in which I’m tempted to use a hammer to break through when things don’t go my way. During these moments, I take a deep breath and remember to be like the water that is more powerful than stone. To evoke the power of this remembrance, I close my eyes and envision water flowing around and between rocks. As I hold this vision, peace and clarity wash over me.
Every day, I do my best to sustain this knowing. And yet, when faced with an obstacle, it is still challenging be like the water and allow my true path to be illuminated.
Balancing Acts
Current thinking argues that humans have unconsciously pursued intellectual, social, even religious kludges to help us overcome the inefficiencies of our nevertheless magnificent brains. I ran across this idea in a book several years ago, Enlightenment 2.0. One example was the idea other people—our social network—should be seen as expansions of our problem-solving mechanics. This is the foundation of social learning theory and a key rationale for why I have pursued learning communities as a key feature of the programs I design and manage here at BHWP.
Another environmental extension of self is writing, which allows us to hold onto thoughts longer, explore them, and rearrange them into more useful products. This expansion of the mind doesn’t stop at arm’s length but extends out into our environments. Libraries, in effect, are external models of our brains; the organizational systems that connect us with titles and the titles to one another are recreations of our neuronal pathways. The well-worn paths in library carpets are the myelinated pathways of a well-practiced skill.
I was thinking of this book and this model again over the weekend when I meditated for the first time in probably 20 years. I had tried to return to this habit of my early 20s several times in the intervening decades and had found myself too easily distracted, too easily transfixed by the worries of the day. So, I sought out the help of an app. The narrator of the guided meditation experience has listeners start with their eyes open, scanning their environment.
When I meditated in college and those few years afterward, my room was a very specific type well-known to bookish types. I’m sure you can imagine it: books piled up by the bed,
psychedelic tapestries on the wall, a concrete statue of Budai in the corner. This environment served as a comfort to me as much as it signaled to visitors of how I wished to be seen.
But when I meditated this weekend, it wasn’t Budai I saw, it was Beatbo—a singing toy and one of my daughter’s prize possessions. Before I could let the thought float away, I realized that my environment is an extension of myself and I’m a parent now. Of course, I knew that already. But the transformative nature of parenthood struck me profoundly at just that moment. Moreover, it started a cascade of thoughts I’m still puzzling out. If an environment like a library can expand our intellectual capacity, can it expand my parenting capacity as well? And here I don’t mean simply expand my capacity to keep my daughter safe (by locking doors and padding corners). I mean, truly expand my powers to model good behavior, responsible rebellion, and critical thinking. Can my environment inspire ethical, moral comportment and artistic curiosity? I’m sure the answer is a resounding, “Yes.”
In the Flow
Recently, I had the opportunity to lead a BHWP Work and Well-Being seminar for medical students at the University of Colorado School of Medicine. One of the activities we include in the seminar is Defining Your Values. We invite students to choose their ten top values, and then, through a process of elimination, whittle that list down from ten to five to three to one. This activity helps students to clarify their values and draw associations between their core values and lifestyle choices. What students discover is that there are often one or two core values under which all other values are subsumed. When our daily lifestyle choices and health behaviors are not aligned with these core values, we may feel unbalanced or disconnected from the natural “flow” of life.
In preparation for the seminar, I thought about the eight dimensions of wellness: emotional, environmental, financial, intellectual, occupational, physical, social, and spiritual. Using a process similar to the Defining Your Values activity, I considered each of the eight wellness domains within the context of my overall sense of well-being. What I learned is that, for me, environmental wellness is the most salient dimension. It is the swaddle that cradles all that is essential to me in life.
Thinking back over the years, I realize that I have been able to make do with gaps in just about every other wellness dimension except environmental. For instance, during my early 20s I had very little in the way of financial resources, so I counted my pennies while living on peanut butter and jelly sandwiches and ramen noodles. My financial picture was bleak, but I knew the sacrifices I made in the moment would lead to better fortunes in the future. Likewise, in my late 30s, I understood that I could tolerate limited social interactions. This was a time of my life when I worked full-time, attended graduate school, and raised a child. In fact, at one time or another in my life, I’ve gone without sleep, 
food, intimacy, and just about everything else we consider essential to well-being. However, the one thing I cannot do without, even for a short time, is a healthy and thriving planet.
When my daily lifestyle and health behaviors align with my deepest respect for and love of the planet, I am healthy and, when I am healthy, I can easily step into and experience the flow. As Joseph Campbell said, “the goal of life is to make your heart beat match the beat of the universe, to match your nature with nature.” Here’s to the flow!