Abstract
Keywords
Recent global events are signaling growing national and cross-nation engagement with the complexities inherent in the practical application of a new vision of health; one that encompasses greater acceptance of wholeness, balanced interconnection, therapeutic pluralism, expanded research paradigms that are inclusive of Indigenous and Traditional knowledge,1,2 and engagement of the relationship between individual, societal and in some cases planetary health.3,4,5,6 I will illustrate this unfolding shift by highlighting Whole Health in the US, global WHO initiatives, and some country-level examples. I will briefly touch on the imperative for new financial models to facilitate this shift.
Runaway cost, systemic inequity, and limited efficacy in care of chronic disease in market-based, fragmented and high-procedural health models,7,8 increased large-scale utilization of TCIM during the COVID-19 pandemic9,10, national commitments to meet Sustainable Development Goals (SDGs), and growing availability of training and regulatory benchmarks for TCIM modalities are some of an array of factors influencing the emergence of this broader vision.
Whole Health
In the United States, there is a growing awareness of the critical role that addressing the whole person through intentional engagement of the multiple dimensions of the self, including mind, body, spirit and community, can play in facilitating sustained improvements in health-related outcomes of interest to the nation.11,12 The 2023 National Academy of Medicine Science & Engineering (NASEM) Report, Achieving Whole Health for the Nation: A New Approach for Veterans and the Nation 13 , resulting from a 4-year investigation of whole health models, signals an important inflection point in the national conversation on health and well-being.
The report defines whole health as “…physical, behavioral, spiritual, and socioeconomic wellbeing as defined by individuals, families, and communities. To achieve this, whole health care is an interprofessional, team-based approach anchored in trusted longitudinal relationships to promote resilience, prevent disease, and restore health. It aligns with a person’s life mission, aspiration, and purpose” (pg. 4). It identifies 5 foundational factors that underpin a whole health approach: 1. People-centered, 2. Comprehensive and holistic, 3. Upstream focused, 4. Accountable and equitable, and 5. Grounded in team well-being. The authors, representing the position of the National Academy of Medicine on this issue, call upon the nation to adopt whole health as a common good and a whole health care approach to address national health needs.
Global Collaboration
At a global level, there are efforts to collaborate toward the development of the conceptual, legal, research, technological, educational, financial and care delivery models needed to facilitate the formal and equitable inclusion of TCIM and planetary health into national health systems. 14 Countries at different stages of integration now have increased collaborative opportunities for cross-learning and consultation.
As an example, The World Health Organization (WHO)’s Global Traditional Medicine Center (TGMC), 15 launched in 2022 in India, is poised to serve as a global hub for research generation and inter-regional collaboration on TCIM. According to the Center, “88% of all countries are estimated to use traditional medicine, such as herbal medicines, acupuncture, yoga, indigenous therapies and others. One hundred seventy Member States report the use of traditional medicine, and their priority request to WHO is for evidence and data to inform policies, standards and regulatory frameworks for safe, cost-effective and equitable use. 16 The WHO has historically supported this request through its Traditional, Complementary and Integrative Medicine (TCI) Unit, which has established benchmarks for training and regulation of several TCIM systems and practices, and through the guiding framework of the WHO Traditional Medicine Strategy. 17
Barriers related to budgets, expanding models for the generation of scientific evidence, regulatory oversight and quality assurance are common hurdles that create a gradient of integration across the globe. Switzerland 18 , for example, has since 2009, incorporated 5 complementary practices into its national health plan, including Homeopathy, Anthroposophic medicine, herbal medicine, Acupuncture and Traditional Chinese Medicine. However, the basic insurance plan pays for these services when provided by a physician. Supplemental insurance is needed when these services are provided by a non-physician licensed professional. Switzerland has established Federal Diplomas for several systems and therapies, including Naturopathy and Ayurveda, which allows them to be legally registered and practiced, even when not reimbursed by basic insurance.
In Portugal, a 2003 law legalized and allowed for the regulation of six complementary therapies: acupuncture, homeopathy, osteopathy, chiropractic, naturopathy and phytotherapy, though the accreditation process was not concretized until 2013, adding also Traditional Chinese Medicine. 19 Bhutan stands on the other side of the spectrum, with strong governmental support for Traditional Medicine since 1968 as well-established, well-regulated and equitably integrated forms of Traditional medical care are provided as part of standard care alongside allopathic care.20,21 India’s Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (Ayush) Ministry of Health 22 provides an example of comprehensive multi-layered integration at a national level.
The Competence Network of Integrative Medicine in Southwest Germany’s Baden-Württemberg stands as a unique state-level example of Integrative Medicine-specific collaboration and integration into existing health care. The network incorporates a range of therapies and systems including acupuncture, yoga, naturopathy, music therapy, among others, is state supported and involves major hospitals in the region. 23
Enhanced opportunities for dialogue, technical consultation across countries at different stages of integration and collaborative research, many WHO-facilitated, are supporting this emergent expansion of broader concepts of health.
The first WHO Global Traditional Medicine Summit, held in 2023 in India, alongside the G20 Health Ministers’ Summit captured key aspects of this expanding global vision. With its overarching theme of Vasudhaiva Kutumbakam, “'One Earth, One Family, One Future,” the meeting further catapulted inter-regional collaboration grounded on acknowledgement of our fundamental wholeness, unity and interconnection as a human family and as one planet. The Summit, with 88 countries represented, mobilized nations toward evidence-based, equitable and respectful inclusion of TCIM, biodiversity and Indigenous Knowledges within actionable national commitments to public and planetary health. The Summit’s official document, The Gujarat Declaration, states that “All members of our one human family live interdependently with our common home, planet Earth, whose health and well-being have a profound effect on the health and well-being of all people.” 24 The closing remarks of Hans Kluge, WHO Regional Director for Europe capture this coming together or nations: “Together, we have gently shaken up the status quo…My pledge today is to take all that I have absorbed to heart; to find ways to build stronger bridges between our various disciplines – all with the aim of bringing about better health outcomes, not only for the almost 1 billion people in the 53 countries of my region – but for the entire world.” 25
Visionary leadership, equitable cross-sectoral collaboration that is inclusive of all stakeholders, and a fundamental re-envisioning of underpinning economic models influencing health care financing are needed for sustained foundational change.
A Word on Health care Financing
In context of the United States the question of payment for care is a fundamental one. This question is being considered within key national bodies. The National Academy Report, Achieving Whole Health for the Nation calls for “seismic change,” including large-scale financial commitments, and notes that the current model is fundamentally unsuited for whole person health. The report includes a call on Congress to create a National Center for Whole Health Innovation to coordinate the multi-sectoral implementation of a whole health approach to care, and further identify key considerations in informatics, workforce, measurement of whole health outcomes, and the financing of whole health as the cornerstones of a foundational infrastructure (pg. 338). The need for extensive integration of services across the dimensions of a person’s life, inclusion of Complementary and Integrative Healthcare as part of standard care packages, and innovative prospective and global health care budgets are implementation considerations in the report that are shared by other nations engaged in similar inclusion efforts within their health systems.
A recent publication by collaborators from the National Center for Complementary and Integrative Health (NCCIH) and Rand Health Care highlights the differential cost of care over a lifetime for a person under a whole person health care model vs. standard care. 26
On a global scale, fiscal allocations needed to implement TCIM and planetary health considerations into national health systems are taking place. According to WHO, preliminary findings from its 2023 Global Survey on TCIM showed that more than 100 countries have TCIM related national policies and strategies, and many have traditional medicines as part of their essential medicines and covered by basic insurance.” 27
An Emerging Vision
A confluence of factors ranging from economic pressures to recognition of valuable contributions of TCIM and greater opportunities for cross-country collaboration are influencing a uniquely promising and unfolding window of opportunity for TCIM systems and Indigenous Health Knowledge to play a pivotal role in the transformation of foundational concepts of health and well-being that embrace wholeness and relate individual health to the health of the planet. The work of the National Academy of Medicine on Whole Health, global efforts by WHO, and the efforts of countries across the world to expand structures of health care, are laying the foundation for the lived experience of this broader vision, one whose fruits may significantly impact for the better the lives of generations to come.
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research and authorship of this article. The author received financial support from Duke Health & Well-Being for the open-access publication fee associated with this article.
