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 Table of Contents  
ONE NATION, ONE HEALTH SYSTEM - SPECIAL ISSUE
Year : 2023  |  Volume : 7  |  Issue : 1  |  Page : 30-34

Scope and implementation strategies to streamline medical pluralism in the contemporary healthcare system


1 Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
2 Vice Chancellor, Manipal Academy of Higher Education, Manipal, Karnataka, India

Date of Submission29-Sep-2022
Date of Acceptance02-Nov-2022
Date of Web Publication08-Dec-2022

Correspondence Address:
Dr. Sanjay Pattanshetty
Department of Global Health Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jras.jras_144_22

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  Abstract 

Medical pluralism in the healthcare system can play a significant role in achieving desired health outcomes. Harnessing the capacity and competency of diverse human resources, effective utilization of available healthcare infrastructure, international cooperation, leveraging partnerships among public and private healthcare sectors in health services, and research and development are key strategies to develop and explore further. Following the guidelines and recommendations of the World Health Organization, traditional medicine strategy can be helpful to translate and contextualize the implementation strategies to streamline medical pluralism in the current healthcare system.

Keywords: Contemporary health care, medical pluralism, traditional medicine, World Health Organization


How to cite this article:
Pattanshetty S, Venkatesh MD. Scope and implementation strategies to streamline medical pluralism in the contemporary healthcare system. J Res Ayurvedic Sci 2023;7:30-4

How to cite this URL:
Pattanshetty S, Venkatesh MD. Scope and implementation strategies to streamline medical pluralism in the contemporary healthcare system. J Res Ayurvedic Sci [serial online] 2023 [cited 2023 Feb 2];7:30-4. Available from: http://www.jrasccras.com/text.asp?2023/7/1/30/362937




  Background and Policy Relevance Top


Medical pluralism and its applications in health care allow for examining the patient beliefs and sociocultural meaning associated with traditional medicine (TM) use, the characteristic biases, norms, conventions, and beliefs hidden in contemporary medicine, and the associated advantages of TM practices. In this context, recognizing medical pluralism as an integrative approach can facilitate healthcare professionals and healthcare systems to enhance patient care and cure.

Eighty percent of the world’s population is projected to use TM. Until now, 170 of the 194 World Health Organization (WHO) member states have stated the use of TM in health care. Most countries collaborate closely with the WHO to generate evidence on the safety and efficacy of products, various practices, and applications to make evidence-informed policy decisions.[1]

TM is either the predominant source of care and cure in society or assists as a support to existing healthcare systems in many countries of the world. In a few countries, nonconventional medicine is called “complementary medicine” (CM). People use CM to manage several ailments, particularly noncommunicable diseases. Ayurveda, Yoga, Unani, Siddha, Homoeopathy, and in some aspects, Chinese medicine are parts of India’s culture. However, spiritualist approaches such as anthroposophy, naturopathy, and other alternative medicine practices are also widely practiced.[2]

The WHO has defined TM as “the total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.”[2]

Dr. Charles Leslie, an American medical anthropologist, involved in understanding various healthcare systems and introduced the concept of pluralism or medical pluralism in his study of Asian healthcare systems during the early 1970s. It refers to a “pattern of coexistence and competition among multiple healthcare systems in a specific region.”[3],[4] People seeking health care can utilize or choose available medical approaches (biomedicine, TM, and CM), modalities of treatment, and healthcare facilities in a pluralistic medical society. The existence of medical pluralism gives people the freedom to co-opt biomedicine and TM or alternative therapies to treat ailments. Even though the concept of medical pluralism was progressing mainly in the 20th century, there was some degree of medical pluralism in every contemporary society historically.[5]

According to Hsu’s interpretation, medical pluralism was used mainly in applied health research than among other professionals because of the growing importance of TM in the current healthcare systems and policies. Other factors such as access to information, mobility of people, exchange of medical goods in global markets, and sharing of healthcare practices in the globalized and interconnected world lead to the growing importance of TM.[6] Globalization has certainly allowed an exchange of data/information, best practices, diversification, and transformation of the world view on available healthcare systems. The transmission and sharing of ideas in an interconnected world provided a platform in which medical pluralism emerged.[7] Building on the context of global assemblages, Hörbst and Wolf discussed the notion of “medicoscapes,” which reflect the diverse medical practices, interrelations, and globalized predicaments in international health settings.[8] The coexistence of diverse medical practices in the national and international health space is based on the differences such as knowledge, origin, justification, rationality, application of knowledge, and various sociocultural and economic issues. The coexistence of diverse health information and the application of that information should be reciprocally supported to achieve health outcomes. Several World Health Assembly (WHA) resolutions and WHO strategies are passed to reinforce the coexistence of biomedicine and TM [Table 1].
Table 1: The WHA resolutions and the WHO Traditional Medicine Strategy

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The resolutions of the 1980s were argued mainly from an economic perspective regarding potential loss to the biomedical community if the medicinal plant becomes extinct. The supporting argument from an economic perspective was deliberated by Farnsworth and Soejarto (1985), who exemplified the economic perspective by estimating the value of a single plant species with potential drug use, should it become extinct.[16] This economic rationalist perspective on medicinal plants and herbs was acceptable to the broader neoliberal healthcare policy environment dominated by the biomedical paradigm. The Alma Ata declaration stressed the need for inclusion of all the healthcare workers such as physicians, nurses, midwives, auxiliaries, community workers, and traditional practitioners and their suitable social and technical training to work together as a health team to respond to the expressed health needs of the community and strengthen the primary health care.[17] For the success of primary health care, the Astana declaration reinforced the need for knowledge and capacity-building in biomedicine and traditional knowledge. In addition to capacity building, the Astana declaration also emphasized the need for healthcare amenities, services, and affordable medicines, including appropriate TMs.[18] The TM strategy 2002–2005 covered policies to advocate, implement, and integrate TM within national healthcare policies and health systems to ensure the safety, quality, and efficacy of TM and to promote equitable access and rational use of TM.[12] The WHO Traditional Medicine Strategy 2014–2023 focused on reconsidering capacity-building, quality assurance, regulations, and incorporation of TM in the existing healthcare systems.[2]


  What Are the Policy Level Challenges in Integrating TM into Healthcare Service Delivery? Top


Policy professionals and healthcare practitioners have frequently raised concerns about the lack of regulatory and legal mechanisms to ensure TM safety, efficacy, and quality. In the year 2002, out of 191 member states, only 25 member states had developed a policy on TM. There is a lack of international standards or mechanisms to ensure the quality of therapy or procedures as TM practices indigenous and embedded within different cultures in diverse parts of the country, both within and between countries. In this regard, efforts are being made to develop standards and methods at the member state or transnational level for evaluating TM. However, the research and development of newer methods and tools to evaluate TM have been inadequate, leading to a lack of understanding of factors influencing the safety and efficacy of TM.[12] In this context, the WHO played a significant role by initiating activities to foster appropriate integration and regulation of TM practices. However, given the diversity and differences in perceptions, existing regulations, and incentive systems among countries, the strategies to implement programs to integrate different systems of medicine must be considered concerning each country’s specific situation.[2] Policy initiatives in TM have mainly stressed the clinical applications and regulations governing TM, with less focus on public health implications. A lack of public health dimension in the application of TM calls for targeted policy priorities, taking into consideration the cultural context, social-political dimension, and fiscal implications to maximize the contribution of TM to healthcare systems and medical pluralism globally.[19]


  Possible Policy Solutions Top


The development of holistic policy for delivering effective public health care can happen by integration at the healthcare professional, organizational, and system levels. Over the last few decades, understanding the importance of medical pluralism at different levels and efforts to bring collaboration among contemporary health care and TM practices are accelerated. However, in the integrative setting, the most challenging task will be the shared decision-making in a clinic. For instance, when should a healthcare professional with biomedicine-focused practice refer a patient to seek health care through TM at any time point of disease management? Jon C. Tilburt and Franklin G. Miller outline a three-point practical approach: inquiring, acknowledging, and accommodating in applying fundamental values of biomedical ethics in medical pluralism. Inquiring, consistent with the principles of nonmaleficence and beneficence, would help clinicians understand and examine the available treatment options outside the purview of conventional treatments.[20] Second, clinicians respectfully acknowledge the diversity in healthcare-seeking behavior and patients’ health beliefs. Due consideration for patient autonomy would assist the clinician in shared decision-making and counseling patients in the right direction. In addition, it would create awareness among clinicians to recognize the confines of the contemporary biomedical paradigm as a way of explaining disease progress and health outcomes.[20],[21] Lastly, accommodating the medical diversity and role of TM in care and cure through evidence-based integrative therapy with a satisfactory risk–benefit ratio would offer added advantage when routine, conventional modalities do not achieve desired health outcomes.[20],[22] Some of the key sectors worth focusing on are mentioned in [Table 2].
Table 2: Strategic sectors to focus on enhancing medical pluralism to achieve universal health outcomes

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  Conclusions Top


The establishment of the Global Centre for Traditional Medicine in India has reinforced the global strategic focus on implementing “The WHO Traditional Medicines Strategy.” This institution is hoped to enhance the cooperation, collaboration, and integration of TM and biomedicine. India can play a leading role in ensuring global policy coherence through evidence generation; capacity-building of diverse health care and social care professionals; creating enabling infrastructure for TM program; supporting public and private institutions; creating mechanisms for public–private partnerships to provide preventive and clinical care; assured global funding in research and development; applying data and advanced analytics to assist countries in evidence-informed policy implementation; and evaluation of TM with the highest importance to equity, sustainability, and innovation. Building a strategic implementation plan to streamline medical pluralism in the current healthcare delivery system is crucial for the country.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

1.
World Health Organization. WHO establishes the Global Centre for Traditional Medicine in India; 2022. Available from: https://www.who.int/news/item/25-03-2022-who-establishes-the-global-centre-for-traditional-medicine-in-india. [Last accessed on 17 Sep 2022].  Back to cited text no. 1
    
2.
World Health Organization. WHO traditional medicine strategy: 2014–2023; 2013. Available from: https://www.who.int/publications/i/item/9789241506096. [Last accessed on 17 Sep 2022].  Back to cited text no. 2
    
3.
Singer P Review of Asian Medical Systems by C. Leslie. American Ethnologist; 1979. Available from: https://www.jstor.org/stable/643404. [Last accessed on 17 Sep 2022].  Back to cited text no. 3
    
4.
Penkala-Gawęcka D, Rajtar M Introduction to the special issue “medical pluralism and beyond.” Anthropol Med 2016;23:129-34.  Back to cited text no. 4
    
5.
Khalikova V Medical pluralism. Cambridge Encyclopedia of Anthropology 2021. Doi: 10.29164/21MEDPLURAL.  Back to cited text no. 5
    
6.
Hsu E Medical Pluralism. Elsevier Inc.; 2008. Doi: 10.1016/B978-012373960-5.00147-7.  Back to cited text no. 6
    
7.
Cant S Medical pluralism, mainstream marginality or subaltern therapeutics? Globalization and the Integration of “Asian” Medicines and Biomedicine in the UK 2020;6:31-51.  Back to cited text no. 7
    
8.
Hörbst V, Wolf A ARVs and ARTs: Medicoscapes and the unequal place-making for biomedical treatments in Sub-Saharan Africa. Med Anthropol Q 2014;28:182-202.  Back to cited text no. 8
    
9.
World Health Organization. WHA29.72 Health Manpower Development. Twenty-Ninth World Health Assembly. Geneva; 1976. Available from: https://apps.who.int/iris/bitstream/handle/10665/86029/Official_record233_eng.pdf?sequence=1&isAllowed=y. [Last accessed on 17 Sep 2022].  Back to cited text no. 9
    
10.
World Health Organization. WHA41.19 Forty-First World Health Assembly. Geneva; 1988. Available from: http://apps.who.int/iris/bitstream/handle/10665/164197/WHA41_1988-REC-1_eng.pdf?sequence=1. [Last accessed on 17 Sep 2022].  Back to cited text no. 10
    
11.
World Health Organization. WHA42.43 Forty-Second World Health Assembly. Geneva; 1989. Available from: http://apps.who.int/iris/bitstream/handle/10665/172238/WHA42_R43_eng.pdf?sequence=1. [Last accessed on 17 Sep 2022].  Back to cited text no. 11
    
12.
World Health Organization. Programme on Traditional Medicine. WHO Traditional Medicine Strategy 2002–2005; 2002. Available from: https://apps.who.int/iris/handle/10665/67163. [Last accessed on 17 Sep 2022].  Back to cited text no. 12
    
13.
World Health Organization. WHA62.13 Sixty-Second World Health Assembly, Geneva 18–22 May 2009: Resolutions and Decisions, Annexes; 2009. Available from: https://apps.who.int/iris/handle/10665/2878. [Last accessed on 17 Sep 2022].  Back to cited text no. 13
    
14.
World Health Organization. WHA67.18 Sixty-Seventh World Health Assembly, Geneva, 19–24 May 2014: Resolutions and Decisions: Annexes; 2014. Available from: https://apps.who.int/iris/handle/10665/260211. [Last accessed on 17 Sep 2022].  Back to cited text no. 14
    
15.
World Health Organization. WHA 69.24 Sixty-Ninth World Health Assembly, Geneva, 23–28 May 2016: Resolutions and Decisions, Annexes; 2016. Available from: https://apps.who.int/iris/handle/10665/259134. [Last accessed on 17 Sep 2022].  Back to cited text no. 15
    
16.
Farnsworth NR, Soejarto DD Potential consequence of plant extinction in the United States on the current and future availability of prescription drugs. Econ Bot 1985;39:231-40.  Back to cited text no. 16
    
17.
World Health Organization. Declaration of Alma-Ata. Declaration of Alma-Ata International Conference on Primary Health Care, Alma-Ata. USSR; 1978. Available from: https://www.who.int/teams/social-determinants-of-health/declaration-of-alma-ata. [Last accessed on 17 Sep 2022].  Back to cited text no. 17
    
18.
World Health Organization. Declaration on Primary Health Care. Global Conference on Primary Health Care. Astana; 2018. Available from: https://www.who.int/teams/primary-health-care/conference/declaration. [Last accessed on 17 Sep 2022].  Back to cited text no. 18
    
19.
Bodeker G, Kronenberg F A public health agenda for traditional, complementary, and alternative medicine. Am J Public Health 2002;92:1582-91.  Back to cited text no. 19
    
20.
Tilburt JC, Miller FG Responding to medical pluralism in practice: A principled ethical approach. J Am Board Fam Med 2007;20: 489-94.  Back to cited text no. 20
    
21.
Callahan D The Role of Complementary and Alternative Medicine : Accommodating Pluralism. Washington, DC: Georgetown University Press; 2002.  Back to cited text no. 21
    
22.
Cohen MH, Eisenberg DM Potential physician malpractice liability associated with complementary and integrative medical therapies. Ann Intern Med 2002;136:596-603.  Back to cited text no. 22
    



 
 
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