Can Health and Wellness Coaches Practice Internationally?

The health coaching market is growing. According to Precedence Research, the global health coach market is projected to grow by 6.7% annually to be worth around $27.8 billion by 2030. Because of the worldwide pandemic in 2020, telehealth and remote visits have exploded, making health coaching even more attractive and viable as a business across the world.

As a result, we at the Center for Health and Wellness Law, LLC receive a lot of questions from aspiring health and wellness coaches about whether and how they can practice beyond their home borders. For many coaches based in the United States, the idea of expanding their practice to clients in Canada, the United Kingdom, European Union or Australia is intriguing. But can they legally offer coaching services internationally? This blog post aims to provide some insight into that question by breaking it into good news and bad news.

First, the good news…

The good news is that very few, if any, countries regulate health coaching. That is good because health and wellness coaches do not have to acquire a special license or certificate from a governmental authority in order to practice health coaching. This lack of regulation may be in part because health and wellness coaching as a profession is quite new, with some stating it really started about 20 years ago. Moreover, according to the International Association of Health Coaches, there is no law of which the organization is aware that prohibits the practice of health coaching. Of course, prohibiting the practice is not the same thing as regulating the practice. But, based on our cursory research, there are few countries that regulate health coaches. For example, most of the European Union does not regulate coaching. See https://ec.europa.eu/growth/tools-databases/regprof/index.cfm?action=map_complex&profession=8005. Most of Europe also does not regulate the practice of nutrition.  See https://ec.europa.eu/growth/tools-databases/regprof/index.cfm?action=map_complex&profession=1382. Of course, it is always a good idea to confirm possible regulation (or lack thereof) in a certain country by consulting with legal counsel.

But, to get the benefit of operating without governmental regulation, health and wellness coaches must “stay in their lane” of coaching and be careful not to slip into the practice of a licensed profession. What is the “coaching lane?” In a nutshell, health coaches aim to help clients “apply their own personal resources and overcome obstacles in the pursuit of a mutually agreed upon goal.” See https://www.researchgate.net/publication/338649074_Competencies_and_training_of_health_professionals_engaged_in_health_coaching_A_systematic_review. In other words, the coach is there for support and encouragement to help clients reach their health and wellness goals. Generally, coaches do not advise, order labs, diagnose or treat. Instead, those words describe the work of licensed healthcare professionals.

The International Coaching Federation (ICF) identifies the following relevant health coaching competencies:

1. Maintaining the distinction between coaching, consulting, psychotherapy and other support professions;
2. Referring clients to other support professionals, as appropriate;
3. Acknowledging that clients are responsible for their own choices;
4. Explaining what coaching is and is not and describes the process to the client and relevant stakeholders
5. Reaching agreement about what is and is not appropriate in the relationship, what is and is not being offered, and the responsibilities of the client and relevant stakeholders
6. Reaching agreement about the guidelines and specific parameters of the coaching relationship such as logistics, fees, scheduling, duration, termination, confidentiality and inclusion of others;
7. Partnering with the client and relevant stakeholders to establish an overall coaching plan and goals
8. Partnering with the client to determine client-coach compatibility;
9. Partnering with the client to identify or reconfirm what they want to accomplish in the session
10. Partnering with the client to define what the client believes they need to address or resolve to achieve what they want to accomplish in the session
11. Partnering with the client to define or reconfirm measures of success for what the client wants to accomplish in the coaching engagement or individual session;
12. Partnering with the client to manage the time and focus of the session;
13. Continuing coaching in the direction of the client’s desired outcome unless the client indicates otherwise;
14. Partnering with the client to end the coaching relationship in a way that honors the experience
15. Considering the client’s context, identity, environment, experiences, values and beliefs to enhance understanding of what the client is communicating
16. Reflecting or summarizing what the client communicated to ensure clarity and understanding
17. Recognizing and inquiring when there is more to what the client is communicating
18. Noticing, acknowledging and exploring the client’s emotions, energy shifts, non-verbal cues or other behaviors
19. Noticing trends in the client’s behaviors and emotions across sessions to discern themes and patterns
20. Facilitating client insight and learning by using tools and techniques such as powerful questioning, silence, metaphor or analogy
21. Considering client experience when deciding what might be most useful
22. Challenging the client as a way to evoke awareness or insight
23. Asking questions about the client, such as their way of thinking, values, needs, wants and beliefs
24. Asking questions that help the client explore beyond current thinking
25. Noticing what is working to enhance client progress
26. Adjusting the coaching approach in response to the client’s needs
27. Helping the client identify factors that influence current and future patterns of behavior, thinking or emotion
28. Inviting the client to generate ideas about how they can move forward and what they are willing or able to do
29. Supporting the client in reframing perspectives
30. Sharing observations, insights and feelings, without attachment, that have the potential to create new learning for the client
31. Partnering with the client to transform learning and insight into action.
32. Promoting client autonomy in the coaching process.
33. Working with the client to integrate new awareness, insight or learning into their worldview and behaviors
34. Partnering with the client to design goals, actions and accountability measures that integrate and expand new learning
35. Acknowledging and supporting client autonomy in the design of goals, actions and methods of accountability
36. Supporting the client in identifying potential results or learning from identified action steps
37. Inviting the client to consider how to move forward, including resources, support and potential barriers
38. Partnering with the client to summarize learning and insight within or between sessions
39. Celebrating the client’s progress and successes

Note that these coaching competencies steer clear of providing individualized, tailored advice to clients, and having proper, transparent agreements is a cornerstone of good coaching practice. Drafting such documents is something we at the Center for Health and Wellness Law, LLC do quite often, so please reach out when you need such assistance.

Now the bad news…

Just because health coaches may not be regulated directly by many, if not most, government authorities (at least from a licensure standpoint), they are likely subject to regulation when it comes to the “unlicensed practice” of a health profession and data privacy regulations.

While much of Europe does not regulate health coaching, as noted above, most, if not all, countries regulate the practice of medicine and other health professions. https://ec.europa.eu/growth/tools-databases/regprof/index.cfm?action=map_complex&profession=12401.  Physicians must have a license to practice in Canada, the United States, the United Kingdom, and Australia, just to name a few countries. See https://www.researchgate.net/publication/281580272_A_Comparison_of_the_Regulation_of_Health_Professional_Boundaries_across_OECD_Countries.

The definition for the practice of medicine is usually quite broad. According to the Journal of the American Medical Association (JAMA), the practice of medicine includes those who “prescribe, direct, recommend, or advise, for the use of any person, any remedy or agent whatsoever, whether with or without the use of any medicine, drug, instrument or other appliance, for the treatment, relief or cure of any wound, fracture or bodily injury, infirmity, physical or mental.”

Unlicensed Practice of Medicine and Foreign Telehealth or Telemedicine Laws

To the extent health and wellness coaches engage in advising on remedies for physical or mental ailments, such activities may trigger unlicensed practice of medicine (or some other health profession) in the foreign country where the client is located. This could be the case regardless of that foreign country’s telemedicine or telehealth laws. Not every country has telemedicine laws (although according to one source, implementing such laws is a growing trend), and those that do may not address the situation where a professional is providing services from a remote country.

The important compliance questions for health and wellness coaches becomes whether they will include advising on remedies to treat health conditions and if so, will the country in which the client is located prosecute such activity. We here at the Center for Health and Wellness Law recommend that health and wellness coaches steer clear of advising on remedies and treatments, and from using “trigger words” that give the impression of practicing a licensed profession. Contact us here if you would like us to review your coaching practice materials for possible compliance issues.

Data Privacy and Security Laws

The other legal issue that impacts both domestic and international health and wellness coaching practices involves data privacy and security laws. Health and wellness coaches often work with telehealth platforms that inevitably collect personal information from clients, such as names, contact information, and personal background information. Whether health and wellness coaches are subject to the Health Insurance Portability and Accountability Act (HIPAA) depends on a number of factors, as discussed in our recent blog post. But HIPAA only applies in the United States. And some states, like California, Virginia and Colorado, have their own privacy laws for health and wellness coaches to consider. See e.g., https://www.jdsupra.com/legalnews/colorado-becomes-third-state-to-pass-8434725/.

Health and wellness coaches that seek to offer their services across borders to other countries like Canada or Europe should be aware of data privacy laws in those countries as well.

Typically, data privacy laws outside the United States are broader and more strict. In Canada, for example, the Personal Information Protection and Electronic Documents Act (PIPEDA) requires businesses that operate in Canada to comply with PIPEDA if they handle personal information. So, a health or wellness coach that serves clients in Canada most likely will be subject to PIPEDA. PIPEDA requires businesses to obtain consent and implement safeguards, among other protections, before handling personal data. For example, to obtain meaningful consent from clients, health and wellness coaches should do the following:

• Make privacy information readily available in complete form, while giving emphasis or bringing attention to four key elements:
  • What personal information is being collected, with sufficient precision for individuals to meaningfully understand what they are consenting to.
  • With which parties personal information is being shared
  • For what purposes personal information is being collected, used or disclosed, in sufficient detail for individuals to meaningfully understand what they are consenting to.
  • Risks of harm and other consequences
• Provide information in manageable and easily-accessible ways.
• Make available to individuals a clear and easily accessible choice for any collection, use or disclosure that is not necessary to provide the product or service.
• Consider the perspective of your consumers, to ensure consent processes are user-friendly and generally understandable.
• Obtain consent when making significant changes to privacy practices, including use of data for new purposes or disclosures to new third parties.
• Only collect, use or disclose personal information for purposes that a reasonable person would consider appropriate, under the circumstances.
• Allow individuals to withdraw consent (subject to legal or contractual restrictions).

See https://www.priv.gc.ca/en/privacy-topics/collecting-personal-information/consent/gl_omc_201805/.

Similarly, in Europe, the General Data Protection Regulation (GDPR) applies to organizations that hold and process personal data of individuals residing in the European Union. See e.g., https://www.natlawreview.com/article/does-gdpr-regulate-clinical-care-delivery-us-health-care-providers. Thus, if a health and wellness coach targets individuals in the EU through advertising to provide coaching services, and that health and wellness coach handles personal data (which is much broader than health data), that coach must comply with the GDPR as a “controller.” One of the primary requirements of GDPR is obtaining consent before processing personal data, which must be:

• Freely given
• Specific
• Informed
• Unambiguous
• Explicit

Id. As a result, if a coach specifically targets a country subject to GDPR, that coach should ensure their practice complies with the law.

For help with health and wellness law compliance, please contact our firm at www.wellnesslaw.com. We are here to be your “go-to” legal and compliance partner!