Strategy for Integration

Nicola Robinson

doi:10.56986/pim.2023.02.001

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Editorial Strategy for Integration: Nicola Robinson^*; Perspectives on Integrative Medicine 2023;2(1):1-2.
DOI: https://doi.org/10.56986/pim.2023.02.001
Published online: February 21, 2023

Emeritus Professor in Traditional Chinese Medicine and Integrated Health, London South Bank University, London, UK

*Corresponding author: Nicola Robinson, Emeritus Professor in Traditional Chinese Medicine and Integrated Health, London South Bank University, 103 Borough Road, London, UK, E-mail: prof.nicky.robinson@outlook.com

• Received: December 8, 2022 • Accepted: December 20, 2022

This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/)

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Keywords: integrative medicine, traditional medicine, complementary medicine, strategy, World Health Organization

Traditional and Complementary Medicine (T&CM) is used worldwide but remains an underestimated part of healthcare by most governments [1]. As demand for healthcare is increasing, particularly given the ageing population, appropriate access to safe and cost-effective treatment should be a goal for all countries.

On 7^th November 2008, the Director General of the World Health Organization (WHO), Dr. Margaret Chan, stressed the importance of integrating traditional medicine into health care.

“The time has never been better, and the reasons never greater, for giving traditional medicine its proper place in addressing the many ills that face all our modern – and our traditional – societies.”

Margaret Chan

This was followed by the WHO traditional medicine strategy 2014–2023, which was launched to the World Health Assembly on 15^th May 2013 [2]. The aim of this global strategy was to foster the appropriate integration of T&CM, its regulation, and education as part of healthcare. It was hoped that by facilitating the integration of T&CM this would encourage countries to develop their own policies, guidelines on standards, and research methodology by stimulating research and promoting evidence-based use [3,4].

By mid-2017, the WHO’s T&CM unit was renamed to include the term “Integrative Medicine.” This was to cover the integrative approaches of both T&CM and conventional Western medicine regarding policy, knowledge, and practice. The WHO now uses the term “Traditional, Complementary and Integrative Medicine.”

In 2019, the WHO reported on the global progress of the initiatives on “Traditional Complementary and Integrative Medicine,” based on contributions from 179 WHO Member States [5]. It stated that in 2018, 98 Member States had developed policies, 109 Member States had launched national laws/regulations, and that 124 Member States had implemented regulations specifically on herbal medicine. However, this varied by geographical region. In South East Asia 91% of countries had a national program of traditional medicines and this was 72% for the African Region, 41% for the Western Pacific, 37% for the Americas, but only 19% for the Eastern Mediterranean, and 13% for Europe. Recent qualitative research from South Africa has demonstrated barriers in regulation and policy in implementing the Traditional Health Practitioners Act [6]. This has been related to a lack of awareness, research, and capacity building.

As part of the implementation of their 2014–23 strategy, during 2021–22 the WHO launched their documentation on international standard terminologies for Traditional Chinese Medicine (TCM), the benchmarks for the practice and training of ayurvedic medicine, unani medicine, tuina, and acupuncture, as well as the key issues on herbal medicines and interactions with other medications [7].

In March 2022, the WHO and the government of India signed an agreement to establish the WHO Global Centre for Traditional Medicine, supported by an investment of 250 million USD from the government of India. The new WHO center will be established in Jamnagar, Gujarat, India [8]. The aim is “to harness the potential of traditional medicine from across the world through modern science and technology to improve the health of people and the planet.” Therefore, there is now the potential for other traditional medical systems such as Indian ayurveda, unani, and naturopathic medicine to be included in the future.

Ensuring healthy lives and promoting well-being for all, and at all ages can only be achieved through universal health coverage, addressing health emergencies, and promoting healthier populations. “Traditional, Complementary, and Integrative Medicine,” can make a significant contribution to the goal of universal health coverage by being included in the provision of essential health services. These principles for integration were identified for TCM in an EU/China project funded by the European Union’s seventh framework program (FP7), through an interdisciplinary collaborative network of over 200 scientists [9].

Another development has been the 11^th revision of the International Classification of Diseases, issued by the WHO which came into effect in January 2022 [10]. It has endorsed traditional medicine paradigms by integrating the coding of diagnostic concepts from both traditional and conventional Western medicine for Chinese medicine as practiced in China, Japan and Korea [11]. This new chapter (Chapter 26) of the 11^th revision of the International Classification of Diseases has been created and has included traditional medicine signs and symptoms, disease names, patterns, indications for treatment and interventions. Pattern differentiation is a critical component of TCM and this initiative should improve the reporting of Chinese syndromes in clinical trials [12] in accurately summarizing the results of clinical trials [13] and influencing clinical practice [14]. A qualitative study of TCM practitioners perceived that in general these codes were valuable, accurate, and incorporated the range of diagnoses used in clinical practice [15].

Interestingly, the decision of the WHO to incorporate TCM concepts acknowledges the global diversity of medicine and was not based on evidence. However, integrative medicine is endorsed in the USA by institutions such as the government, National Institutes of Health, Food and Drug Administration, and Medicare. The importance of patient centered care and patients’ preferences is important if there is to be equity and inclusive provision, and universal health coverage.

So, despite the backing by the WHO, the degree to which traditional, complementary, and integrated medicine is accepted, and is integrated into health care systems in different countries continues to be variable. There are various issues that remain to be explored, so what evidence is required by policy makers, how can we build the evidence base collaboratively, and what research is needed?

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Conflicts of Interest

Nicola Robinson is an editor of Perspectives on Integrative Medicine but this had no influence in the decision to publish this article.

Ethical Statement

This research did not involve any human or animal experiments.

Funding

None.

References

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[2] World Health Organization. WHO traditional medicine strategy: 2014–2023. Geneva (Switzerland), World Health Organization, 2013.
[3] Burton A, Smith M, Falkenberg T. Building WHO’s global Strategy for Traditional Medicine. Eur J Integr Med 2015;7(1):13−5.Article
[4] Falkenberg T, Smith M, Robinson N. Traditional and Integrative approaches for global health. Eur J Integr Med 2015;7(1):1−4.Article
[5] World Health Organization. WHO global report on traditional and complementary medicine 2019. Geneva (Switzerland), World Health Organization, 2019.
[6] Weaver C, Shezi B, Street RA, Ranheim A, Falkenberg T. Balancing the global traditional health agenda and local realities in South Africa: From perspectives to action. Eur J Integr Med 2020;38:101123. Article
[7] World Health Organization [Internet]. Traditional, complementary and integrative medicine: Available from: https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine
[8] World Health Organization [Internet]. WHO Global Centre for Traditional Medicine: Available from: https://www.who.int/initiatives/who-global-centre-for-traditional-medicine/
[9] Xu Q, Bauer R, Hendry BM, Fan TP, Zhao Z, Duez P, et al. The quest for modernisation of traditional Chinese medicine. BMC Complement Altern Med 2013;13:132. Article PubMed PMC PDF
[10] World Health Organization [Internet]. International Classification of Diseases 11th Revision: 2022 [cited 2022 Dec 08]. Available from: https://www.who.int/standards/classifications/classification-of-diseases
[11] Reddy B, Fan AY. Incorporation of complementary and traditional medicine in ICD-11. BMC Med Inform Decis Mak 2022;21(Suppl 6):381. Article PubMed PMC PDF
[12] Zhang X, Tian R, Zhao C, Birch S, Lee JA, Alraek T, et al. The Use of Pattern Differentiation in WHO-Registered Traditional Chinese Medicine Trials – A systematic review. Eur J Integr Med 2019;30:100945. Article
[13] Kim T-H, Tian Z-Y, Liao X, Robinson N. Essential elements required for conducting and structuring an overview of systematic reviews in the field of traditional and complementary medicine. Eur J Integr Med 2022;49:101605. Article
[14] Birch S, Lee MS. Pattern identification – A key to clinical practice in traditional East Asian medical systems. Eur J Integr Med 2020;38:101174. Article
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Strategy for Integration

Perspect Integr Med. 2023;2(1):1-2. Published online February 21, 2023

DOI: https://doi.org/10.56986/pim.2023.02.001

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Strategy for Integration