The World Health Organization’s (WHO’s) Traditional Medicine Strategy 2014-2023 may be most remarkable for its positioning of traditional and complementary medicine (T&CM) “products, practices, and practitioners” – a repeat phrase in the document—as part of the WHO mission of establishing “universal health care” (UHC). The top goal is “harnessing the potential contribution of T&CM to health, wellness, people-centered care, and UHC” (p 43). One of three strategic objectives is more explicit. Traditional products and services are viewed as levers in “promoting universal health coverage by integrating T&CM services and self-health care into national health systems” (p 8). The strategy explicitly recommends that this means “integration into the national health system including reimbursement, potential referral, and collaborative pathways.”
Throughout, the document suggests that T&CM can be significant contributors to a key need: cost savings. Two European studies are referenced (p 29). Demand for T&CM is associated with concern about escalating costs (p 25). Its “economic importance” is framed in part as a role in “actually reducing healthcare costs” (p 18). For those familiar with the move toward “values-based” medicine in the United States as evidenced in the Triple Aim, the strategy urges WHO member nations to examine how T&CM can lead not only to cost savings but also to the other two legs of the Triple Aim stool: “how T&CM may improve patient experience and population health” (p 19).
Comment: I was honored to be part of two of the four working groups (the second in 2012, and fourth in 2013) assembled by WHO to support preparation of the strategy. In that capacity, one is also quite aware that the distance between dialogue, decision, and dissemination is one marked by multiple other interventions. Still, it is pleasing and remarkable to see WHO take T&CM so seriously. That some 80% of many populations is believed to use traditional medicine for part of their primary care certainly drives this embrace. The data increasingly support this general direction. See the studies referenced at the Project for Integrative Health and the Triple Aim.
At the same time, the movement in the United States and other nations with awfully expensive and overdeveloped medical industries toward the outpatient services, self-care, community partnerships, and the determinants of health suggest that global health is trending toward less separation between traditional and industrial practices. Talk about “transforming” the medical system in industrial nations from the present bullying leadership by the tertiary care segment is wonderfully captured in the WHO strategy. The authors write that the “predominance of curative, hospital-based, disease-oriented services” is “poorly integrated into the broader health systems” (p 35).
The systems thus presented are already flipped. Communities are the base rather than the institutions in nations where the determinants of ill health include excessive invasiveness and over-production of services that may account for, in the United States alone, more than 250,000 deaths a year. While policy wonks in most developed nations will likely look down their noses at this plan as a tool, at best, for the less developed, those seeking to drive transformation may find in this strategy multiple useful directions.
Note: From time to time, I will return to this WHO document for additional perspectives. Please feel free to share with me your views on the value (or not) in the strategy.