Wellness and health in Lebanon: current status and potential for growth.
Health and wellness have long been an integral part of Middle Eastern culture. The most common Arabic phrase used for greeting someone-- keef el-sohat? --asks after a person's health. Another common phrase used in Lebanon specifically is yatik el-afyeh (may God grant you wellness), used as a greeting but also for when someone is engaged in physical labor or has had a busy day.
While our language may emphasize the value we Lebanese place on health and wellness, our habits and activities have gradually shifted away over the years as a result of exposure to unhealthy trends in food and lifestyle. "The Lebanese basically have a very healthy diet, but it has been unfortunately transformed by imported American trends," says Alice Edde, co-owner of Eddesands Hotel & Wellness Resort. "But the Lebanese are very beauty conscious, so anything that had to do with weight loss was always a big success. Although for us wellness is more than just weight loss, it is the trick to get people into it."
The tendency towards unhealthy habits may be beginning to change, however, as part of a global movement toward encouraging a good quality of life. In Lebanon, interest in health and wellness practices is slowly increasing as more stakeholders realize the benefits of a healthy lifestyle--which can include activities such as yoga and meditation--in preventing illnesses and in achieving balance.
Wellness around the world
Wellness as a concept has existed since ancient times: the Indian Ayurveda system of medicine, based on the belief that good health depends on a delicate balance of mind, body, and spirit, has, for example, been around since 1500 BC. Worldwide, wellness as we now know it in the modern world began to gain ground on Western medicine relatively recently, starting in the 1790s with the introduction of homeopathy by the German physician Christian Hahnemann.
It was not until the 1980s, however, that the wellness movement began to be taken more seriously in the medical, academic, and corporate worlds, with the introduction of more workplace wellness programs and with the boom of the fitness and spa industries, according to the Global Wellness Institute (GWI).
In 2015, wellness was a $3.7 trillion industry globally according to the GWI, an admittedly partisan source, and it is only growing further as more people become aware of the role that leading a healthy lifestyle plays in their general wellbeing and in the prevention of illnesses.
A healthy new Lebanon
Lebanon is just awakening to the wellness industry and while it still has a long way to go to reach global levels of economic output and prevalence, the seeds are surely being planted and the potential is there.
Maya Romani, assistant professor of clinical family medicine at the American University of Beirut Medical Center (AUBMC), says that when the American University of Beirut (AUB) first introduced its wellness program in 2006, "the idea of wellness was not very common among healthcare professionals in Lebanon, who mainly worked on treating diseases."
Interest in wellness from the AUB community and the public has been increasing, says Romani, noting that their first annual wellness fair in 2015 gathered only 200 attendees, while last year's drew in 600.
In 2015, AUBMC established an integrative medicine center, the first of its kind in Lebanon and the Middle East. "There is a huge worldwide demand, with everyone talking about evidence-based complementary and alternative medicine. So we thought that AUB, being a leader in the fields of education and medicine in Lebanon, and taking in consideration the high demand for such non-conventional medical services, should have its own services that target those people that are seeking non-conventional medicine pathways, especially those [practices] that have a very strong evidence of success," explains Romani.
Photo by: Greg Demarque/Executive
When Edde first arrived in Lebanon in 2003, she recalls that wellness was a brand new concept. Today, wellness has become more established, she says, although the focus is still mainly on its nutrition and diet aspects. "There is more of a desire among Lebanese to go into the global wellness approach: There is a lot more interest in yoga with yoga studios opening everywhere, you have a lot of 'do it yourself' healthy cooking classes or things to do with aromatherapy. So, there is definitely an interest, although so far they have their niche clientele," explains Edde.
She has been organizing bi-annual wellness weeks since 2012, but says that Eddesands has found it easier to sell tailor-made packages or individual treatments for a short duration of time, as opposed to tickets to the wellness week in its entirety. "Wellness as a holistic package is still hard to sell because there is still a lack of awareness about it and because the term has been somehow misused in Lebanon. So when people call for our wellness services, they sometimes mean just a spa beauty treatment. When you explain that wellness is mind, body, and that our wellness week is a journey and a holistic experience where you eat well and participate in all physical activities with us and do the meditation, etc., it becomes more difficult to sell as a package," Edde says.
Why invest in wellness?
A lot of the interest in wellness and health is caused by its direct relation to the prevention of illnesses and injury. Romani says that the main benefit of incorporating wellness into one's life is its proven ability to decrease healthcare costs. She cites a 2010 Johnson and Johnson study that shows that for every $1 spent on the wellness of an employee, $5 are saved on the employee's healthcare costs. "Most of the studies [on wellness] concentrate on the [reduction of] healthcare costs and there is good evidence that it works," Romani says. As such, the wellness center at AUBMC works with the employee unit and human resources at AUB to design obligatory wellness programs (such as anti-stress activities for ICU nurses, or how to properly carry heavy loads when housekeeping) which aim to target key reasons that employees might take sick leave from work.
Insurance companies have also realized that investing in wellness can reduce healthcare costs. Romani notes that some companies in Lebanon now cover acupuncture in certain cases. Meanwhile, Libano Suisse Insurance offers a wellness program with services that include wellness coach consultations, dietitian questionnaires, and physician consultations. The program also incentivizes clients to work on their health and wellness by offering them rewards such as discounts on its services and vouchers for healthy foods.
Christelle Bachi Gedeon, president of the Syndicate of Dietitians in Lebanon, says that the syndicate has been trying to work with the National Social Security Fund (NSSF) to promote healthy diets, by focusing on the reduced cost of healthcare to motivate the NSSF. "Countless studies have proven that a good diet can prevent diseases. The NSSF pays for people's medications, so if they improve people's wellness through a healthy diet, they will reduce the cost of medication on themselves," Gedeon says.
Being healthy is also a means of increasing productivity in the workplace. "Stress is one of the biggest diseases of the century, so when we combat stress, we are actually preventing many of the illnesses that could develop from it," Edde says. "Think about the productivity level increase that happens when you have such treatments: If you have one day a week for yourself, you can achieve more the rest of the week."
Despite the evidence that wellness has a direct effect in lowering the risk of injuries and illnesses, it is yet to be embraced fully by conventional medical practitioners. While worldwide wellness centers are integrated into healthcare centers and hospitals, this is still rare in Lebanon--with the exception of AUBMC's integrative medicine center.
Doctors are also often reluctant to prescribe non-conventional treatments (such as yoga or acupuncture) alongside medications, although this is starting to change. "We are getting more people who say we are here because their doctor recommended [it]," says Hala Okeili, founder of Sarvam Yoga center in Gemmayzeh. "This is usually in cases of high blood pressure, back pain, or osteoporosis. I don't think this collaboration is very explicit in Lebanon yet, although it is very present outside of the country. I think there is a growing awareness of the relation between traditional medicine and wellness in Lebanon, and doctors who are open minded are currently recommending wellness practices, but it's not an explicit and direct relation yet." (For more on yoga in Lebanon, see box above.)
When it comes to nutrition, not all doctors feel that a dietitian is needed to prescribe a healthy re gime for their patients. "The newly trained doctors are increasingly referring their patients to dietitians but previously it was a struggle as many old school doctors believed their education qualified them to prescribe diets if needed, when it doesn't--just like my degree does not qualify me to give medical advice," Gedeon says. "But thankfully, new doctors know the value of a good diet, so the change is happening and as long we are fighting, we will get there." She adds that the syndicate was invited to speak at the 21st Lebanese Congress of Surgery in June, indicating that nutrition is being taken more seriously in Lebanon.
Part of the work done by the integrative health center at AUBMC is academic, in that they provide a space for medical students to train in wellness, explains Romani. "Most of the time, students studying medicine are not exposed to wellness as part of their curriculum. At AUBMC we have an elective rotation on wellness and integrative health which will commence next academic year. Also, as part of the family medicine rotation, students are exposed to integrative health through two sessions. This is because medical students have an important role in referring their patients to the appropriate wellness specialty," says Romani.
Health is wealth
One of the reasons why wellness activities are not very prevalent in Lebanon could be the perception among Lebanese consumers that these activities come with a high price tag. Edde does not believe wellness needs to be costly. "I think there is a misconception about wellness being expensive. There's no need for it to be expensive. Wellness is a natural healthy way of living; it is a mindset. For example, instead of taking the car, you walk, or you have a homegrown garden on your balcony instead of buying expensive organic food. There are many healthy habits that you can introduce into your life which are free."
For those with a lower socio-economic status, even carefully priced wellness activities could be restrictive. AUBMC's Romani says they charge $10 per yoga, tai chi, or mindful meditation class, but even that is a barrier to some of the staff at AUB and AUBMC. "When we gave a free mediation session for all staff, we had 50 attendees, while when they had to pay LL15,000 we barely had a few staffers. We try to give more free sessions, but at the end of the day, we have to pay our employees," she says.
Some wellness activities are priced so highly that they could hinder the industry's growth. When it comes to life coaching, where a single session averages $100 and multiple sessions are often needed, money is certainly a hinderance, according to Grace Khleif, a certified life coach. "It is not for everybody, and this is the sad part because a lot of young women who are starting their career and come to me don't earn much, so it is always a struggle to pay the fees," says Khleif, explaining that this is one of the reasons why she introduced group life coaching sessions, for which the fees are lower, although the experience is not as personalized.
Photo by: Greg Demarque/Executive
Khleif says that those who have make the hefty investment into life coaching find that it is extremely valuable in terms of their personal growth and development. Indeed, all of those interviewed for this article agree that investing in wellness--despite the cost--is worthwhile, because investing in your health and wellbeing is ultimately more rewarding than spending money on temporary experiences or products. "I wouldn't say yoga is expensive. At the end of the day, if you are doing something that would help you avoid taking pills and going to doctors, then I would say it's a cheap investment for your health," says yoga instructor Okeily.
To Edde, it's all about priorities. "You have to take into account that the more you spend on your wellbeing, the less you spend on your illness or treatment later, so there is a balance there. To me, it is about priorities: Instead of spending money on going out, you can spend it on a spa treatment or yoga class. It is about knowing where and how to spend your money," she says.
Consult a professional
In a country like Lebanon, where there are no regulations regarding non-conventional healthcare, it can be difficult for consumers to discern between qualified wellness instructors and snake oil salesmen. As such, many wellness instructors get certified from international bodies in their field (the American Yoga Alliance, for example, or the International Coach Federation [ICF] for life coaches) and urge potential clients to ask about credentials. "A lot of people here think coaching is sprouting anywhere and anyone can do it, but in ICF Lebanon we are trying to raise awareness on the need for clients to ask their coaches about their level of accreditation, certifications, and hours of experience before they hire them," says Khleif.
Gedeon says that the dietitians' syndicate urges customers to ask their dietitians not only about their medical degree but also about their work license, which is granted to them by the health ministry after they complete their training and pass the colloquium exam, an official test given by the Ministry of Public Health that grants healthcare providers a license to practice in Lebanon. "The good thing about Lebanese is that they are talkers: If a certain dietitian does not have a degree, they will be quick to let everyone know. Once they are aware of what to look for, they are very important agents of change. Therefore, we encourage all clients to ask for the dietitians' university degree and work license. Some graduate from universities but fail the colloquium or don't do their training and so can't sit for a colloquium. Hence, asking a dietitian about her work permit is very important," explains Gedeon.
When it comes to physical exercise activities such as yoga, credentials do not a good teacher make, and this is where word of mouth and customer experience comes into play. "You can have certificates but not be a good teacher, so it depends on many factors," Sharon Ghanime, a local yoga instructor, says. "Lebanon is small, and the yoga community is smaller, so you can easily know who a good teacher is, or not. So, word of mouth is key until the market becomes really saturated and people have to bring their credentials into play."
As wellness starts to take root in Lebanon, one cannot help but wonder if the country has the potential to develop a wellness tourism industry. Some, such as Edde, believe that Lebanon has great potential for such tourism. "If we can attract foreigners for medical tourism, it would contribute to the economy positively. We have so many sunny days a year that we can shift the trend toward this kind of tourism," she says. "For example, if somebody has surgery in Lebanon, they can have a wellness treatment afterwards to recover from their surgery. There are small hotels or resorts and spas all over the country, or you could stay in a guesthouse and come for your treatments at a nearby spa. Once you get out of Beirut there are a lot of possibilities."
But others, such as Sarvam Yoga's Okeili, argue that if the current destruction of Lebanon's natural resources continues, other parts of the world will provide a more serene backdrop for wellness.
Although Lebanon may not yet be ready for wellness tourism, there is still a lot of potential for the health and wellness industry to enhance the quality of life of the local population. The seeds are already planted, and the interest is there, but what is needed, as always, is a solid strategy and development plan. The Ministry of Public Health first needs to be convinced of the value of investing in wellness and health in order to ultimately reduce the curative healthcare cost on themselves. Once this happens, they can start working with various stakeholders, from syndicates to insurance companies, on awareness campaigns, activities, and actions that would make the notions of wellness and health more recognizable among the Lebanese. Until this happens, all we can do is to try and keep healthy as we wait.
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|Publication:||Executive (Middle East)|
|Date:||Aug 7, 2018|
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