Not so long ago, folks sought medical care only when they needed to get well; today, medical care is routinely sought by those who want to stay healthy.
North County has neighborhood clinics, alternative-care practitioners, workplace programs, classes and activities designed to help people achieve good health.
The concept of wellness is being approached from a variety of viewpoints, and is considered more than the opposite of sickness. One health maintenance organization defines it as "a state of optimal health that involves the 'whole' person: physical, intellectual, spiritual, social and emotional."
The Well Being, a health education program at Scripps Memorial Hospital in Encinitas, is among local institutions dedicated to the concept of wellness. It is a clearinghouse of information and the site of dozens of classes, many of which are free but some with fees ranging from $5 to $20.
The center offers blood pressure, cholesterol and diabetes testing, as well as sessions on more specialized topics, such as foot care, sports medicine and laser eye surgery.
The Well Being also has arts and crafts classes, seminars on a range of topics, including financial planning, and a presentation called "Happy Thoughts . . . Happy Life." The wide variety of offerings is in keeping with the concept of wellness as a comprehensive and preventive approach to health care.
Another wellness center in North County is The Health Concern in Escondido. Affiliated with the Palomar Pomerado Health System, the Health Concern offers community members a variety of health education workshops, support groups, literature and a speaker's bureau, at little or no cost.
Similar education services are offered by other community health care providers, including Mission Park Medical Clinic, North County Health Services and Sharp Rees-Stealy Medical Group. All offer health education programs with an emphasis on prevention.
Increasingly, the workplace is also a good source of wellness information.
Many area employers contract with clinics to provide their employees with prevention programs. Clinics often set up these educational outreach programs by coordinating with health maintenance organizations, known as HMOs. With a strong emphasis on prevention, HMOs are at the center of an ongoing transformation in how health care is delivered.
In an HMO, a group plan provides all medical care for each individual in the group at a fixed monthly fee. Primary care physicians become gatekeepers, who must tell some patients that they don't need to see a specialist.
In HMOs, restricted access to expensive and sometimes unnecessary treatments is balanced by greater access to preventive health care, including classes that teach people healthier ways of living.
"The top 10 killers in our society today are related to lifestyle," said Chery Woodard, director of member health education in San Diego County for Kaiser Permanente.
Educating people about the risks associated with smoking, poor diet and stress can help them live longer and better, she said.
"Helping people take control over their lifestyle gives them more self-esteem and a better quality life," Woodard said.
One area company that takes full advantage of the wellness philosophy is Carlisle Memory Products, a computer hardware manufacturer in Sorrento Valley.
Cynthia Sundahl of Carlisle's human resources department plans monthly health education presentations for employees. She works closely with Health Net, an HMO based in Woodland Hills. The presentations focus on themes such as how to lower cholesterol or how to start an exercise program. Typically, there is an initial lecture or videotape, an opportunity for employees to become involved, then a follow-up speaker.
Sundahl has arranged for a dietitian to come in and give cooking demonstrations at lunchtime. The dietitian will also look at an employee's recipes, and give suggestions for making them healthier. The company has also provided cholesterol testing, and set specific targets for lowering cholesterol levels company-wide by next year.
In addition to Health Net, Sundahl gets health education information from the American Heart Assn. and the Business Health Institute at Scripps Memorial Hospital in La Jolla.
Blending information from these sources, she has created a tailor-made program, and, so far, employee participation and enthusiasm are high, she said.
The cost of starting such a wellness program is minimal, yet the benefits to both the company and the employees are great, Sundahl said.
"You have to have a goal, and that goal is to improve your employees' health, because it saves your company money," Sundahl said. "It's good for them and it's good for us."
Another employer, General Atomic, located in the Torrey Pines area, takes the idea of prevention a step further by providing employees with a fitness center that includes a weight room, swimming pool and tennis courts.
Employees can use the facilities before or after work or at lunch, and they are free to bring their families in outside of work hours. In addition to keeping employees in good shape, the fitness center also serves to help attract high-caliber workers.
"It does help with recruiting," said Jim Edwards, a vice president at General Atomic. But the question must be asked: Does access to workout equipment actually help employees' performance, and thus the company's bottom line?
"That's kind of a hard thing to prove," Edwards said. "Personally, I work out first thing in the morning, and it seems to give me more energy. It's more an article of faith that anything that can be documented, though."