25 Aug, 2003
Good News For The Health-Travel Industry
Traditional medicine is making a global comeback. Spas and health centres will find this upcoming document a major blessing.
1. GOOD NEWS FOR THE HEALTH-TRAVEL INDUSTRY: AN ATLAS OF TRADITIONAL MEDICINE
Spa and health centres in the Asia-Pacific will be pleased to know that the World Health Organization (WHO) is compiling the world’s first Global Atlas of Traditional Medicine, due out in spring 2004. The atlas is part of a WHO campaign to boost usage of traditional medicine worldwide. Although primarily intended to benefit the world’s poor, the campaign could yield significant benefits for the rich customers of spas and health centres.
More than 70 experts from 33 countries gathered in Kobe, Japan, last June 2003 to review the draft atlas which is being compiled by the WHO’s Centre for Health Development. They included representatives from the WHO Headquarters and Regional Offices, international experts in traditional medicine, national policy/decision-makers, nongovernmental organizations and other interested groups and individuals.
WHO officials note that compilation of such an atlas is no easy task. Very few countries have comprehensive surveys in the area of traditional and complementary medicine. Adverse political and economic conditions in some countries have meant great difficulty in collecting and collating data, leading to gaps in the available information among regions.
The meeting chairperson, Mr Nimal Siripala De Silva, a Member of Parliament in Sri Lanka says that once the information gaps are plugged, the atlas will go a long way towards raising awareness of the importance of traditional medicine. The WHO feels the regional health industry as a whole has much to gain from the dissemination of reliable information regarding traditional medicine/complementary/alternative medicine (TRM/CAM) policy, regulation, practices and utilization.
The atlas is a part of the Strategy for Traditional Medicine that the WHO is implementing for 2002-2005. WHO studies show that the importance of traditional medicine is coming to the fore worldwide because it is affordable to low-income people and saves national treasuries millions of dollars in imported Western-approved medications.
WHO studies indicate that in most countries, the medical situation can be divided into four categories: 1) Monopolistic, where only modern medical doctors have the sole right to practice medicine. 2) Co-existence where traditional medical practitioners, while not formally recognized, are permitted to practise in an unofficial capacity. 3) A Parallel model, as in India, where both modern and traditional medicine are separate components of the national health systems. 4) An Integrated model where modern and traditional medicine are integrated at the level of medical education and practice.(e.g. China, Viet Nam).
The WHO feels that Asia has seen the most progress in incorporating traditional health systems into national health policies. This trend began 30-40 years ago and has accelerated in the past 15 or so years. In some Asian countries like China, this has been the result of official policy while in others like India and South Korea, change has come about as a result of a process of politicisation of the traditional medicine agenda.
In China in 1995, according to the WHO, there were 2,522 traditional medicine hospitals as against only 678 in 1980. These hospitals treat 200 million outpatients and almost 3 million inpatients annually. Roughly 95% of general hospitals in China have traditional medicine departments which treat about 20% of outpatients on a day-to-day basis. There are 30 universities or colleges for traditional medicine in China.
In 1995, China produced 17.57 billion yuan worth of herbal medicines, an increase of 212.6 % since 1990. That year, sales of herbal medicines accounted for 33.1% of the drug market in China. In 1980, China was the first country to negotiate a component for traditional medicine within a World Bank health sector loan. A more recent World Bank-financed expansion of hospital beds included a provision that 20% of these would be in hospitals of traditional medicine.
In South Korea, 11 colleges provide formal education on traditional medicine. Established by law in 1952, the parallel operation of Western biomedicine and Oriental medicine (OM) is one of the prominent aspects of the health care service, according to the WHO.
In 1996, there were 9,299 licensed OM practitioners compared to 59,399 Western practitioners. Almost all OM hospitals and primary clinics are privately owned and operated. Political conflict between the Korean OM and modern medical sectors was high during the 1990s over issues of fees, ability to sell and prescribe traditional herbal medicines and licensing of traditional practitioners.
In India, the formalisation of indigenous medicine was adopted when the Central Council Medicine Act was promulgated in 1970, after going through a century of committees. The Act set up a Council to oversee the development of Indian Systems of Medicine and to ensure that standards of training and practice were developed.
Over 100 training colleges in traditional medicine have since emerged. In 1995, a Department of Indian Systems of Medicine (ISM) was set up and made it a priority to upgrade training in ISM <http://indianmedicine.nic.in/>.
Political factors are associated with the advancement of indigenous medicine in India. After decades of under-funding, the current pro-tradition BJP Government has doubled the budget for ISM. Due to the high cost and unavailability of modern medical services in rural India, the government has undertaken to add ten medicines from the Ayurvedic and Unani systems into its national family welfare program. A pilot project, designed to finish this year, is being implemented in 7 Indian states for Ayurveda while Unani medicines are being introduced in 4 cities.
WHO has also been promoting the use of traditional healers in Africa. During the 1990s, traditional health practitioners played an important role in HIV/AIDS education and care, in delivering child survival messages and in managing endemic disease in partnership with modern healthcare workers. There is now an emerging momentum to begin a process of formalisation of traditional medicine in Africa, with countries like Uganda, South Africa and Ghana taking the lead.
The WHO is concerned that as developing countries begin to encourage formal health services in traditional medicine, the debate on these services is also shifting from a language of equity and quality of care to one of efficiency and cost, as in the US.
In the developing world, the cost of “modern” medical services is an important reason why people turn to traditional medicine. Currency devaluations further raise this cost. In Vietnam, a rural expression states that traditional medicine can be paid for with one chicken, modern medicine can cost one cow and hospitalisation can cost a family its herd of cows. Such sacrifices by poor families may be made at the expense of their future livelihood.
The role of insurance coverage for traditional/complementary medicine is also under scrutiny. In the industrialised countries, where almost half of the population regularly uses complementary medicine, insurance coverage for this is still relatively new. Amongst the Korean immigrant population in Los Angeles, 24% of the uninsured used traditional healers, compared with 59% of persons with Medicaid only and 71% of those with other types of insurance including Medicare and Medigap coverage.
In China, although traditional health services are covered by health insurance, only about 12% of the population has comprehensive medical insurance that covers the cost of hospitalisation. The proportion of uninsured people may be as high as 50%. In Taiwan, the experience is that insurance coverage for traditional medicine would more than double the use of TCM.
At the same time, however, high profitability of traditional medicine can lead to its custodians resisting moves to provide insurance coverage for their services and products. In Korea, where the profit margin of herbal medicines is variously estimated to be 100-500% compared to their basic cost, the population utilise herbal medicines on a large scale.
In New Zealand, which has a long tradition of universal insurance for medical and hospital services, a number of Maori organisations signed contracts with regional health authorities to provide primary health care, resulting in an increased number of Maori-controlled services throughout the country.
New Zealand has allowed the registration of more than 600 Maori traditional healers and the government reimburses their services under health insurance schemes. In Australia, since the introduction of a Medicare rebate for acupuncture in 1984, use of acupuncture by medical practitioners has increased greatly.
Recent research at Oxford University suggests that a search for satisfaction in the treatment of chronic disease is the primary reason why people in Britain – particularly women – seek the services of complementary health care providers. Ethnic minority groups in the UK, for example, are known to prefer their own traditional forms of medicine, such as acupuncture and traditional herbal medicine, to such Western systems as chiropractic and osteopathy.
WHO’s Quality of Life Assessment includes spiritual dimensions in assessing an individual’s quality of life. Here, “spiritual” relates to the sense of meaning regarding the self or extending beyond the self. The spiritual dimension of life and well being is central to many traditional and complementary health systems.
Who studies are also calling for more research into traditional and complementary medicine, especially taking into account the needs of women, children, the poor, the elderly and those with special medical conditions. Both political and scientific will are needed to support such an agenda. Legislators in industrialised countries are coming to recognise that the use of complementary medicine is linked to votes – votes of the wealthier and more educated sectors of society.
Further information on WHO’s activities in the field of traditional and complementary medicine can be found at : http://www.who.int/medicines/organization/trm/orgtrmmain.shtml
The document: “Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A Worldwide Review” can be found at: http://www.who.int/medicines/library/trm/who-edm-trm-2001-2/legalstatus.shtml.
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