|Year : 2022 | Volume
| Issue : 2 | Page : 89-90
The role of traditional medicine in public health
Professor, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
|Date of Submission||07-Jun-2022|
|Date of Decision||07-Jun-2022|
|Date of Acceptance||07-Jun-2022|
|Date of Web Publication||12-Jul-2022|
Professor, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Priya R. The role of traditional medicine in public health. Indian J Public Health 2022;66:89-90
The mandate of public health requires understanding the dynamics of health and disease; using this knowledge to devise promotive, preventive, curative, palliative, and rehabilitative measures; and then designing systems for organized provision, access, and utilization of the measures to improve population health. These tasks have been performed in diverse ways by the various traditions of health knowledge that have developed during different periods in human history at different locations globally. Many of these knowledge systems remain live traditions in contemporary times – traditional Chinese medicine, Ayurveda, Unani, Siddha, SowaRigpa, and American indigenous medicine, among others – together with the dominant tradition of conventional, cosmopolitan, bio-medicine. The other knowledge systems are collectively called traditional medicine (TM) based on their origins being much earlier than modern medicine (MM), or complementary and integrative medicine (CIM) since they are perceived as adjuncts to dominant MM. Their relevance and roles are many, envisaged from diverse vantage points.
Available data show that a vast majority of the world's population utilizes the knowledge of various systems including TM and MM. The TM in practice includes both formally recognized medical systems and informal practices such as home remedies for self-care by individual, family, and community. Hygiene and sanitation, food and diets, child care and elderly care, and palliative and curative treatments – these are intrinsic components of the diverse formal and informal systems. Thereby they continue to play a role in health care to varying degrees in all countries.
| Issues for Contemporary Public Health and an “Integrative Health System”|| |
While dominant epidemiology and health systems research (HSR) have tended to ignore TM, the WHO and national governments have responded to demands for their recognition. Hence, their contemporary development and PH tend to run as parallel systems. There has been strong opposition to suggestions for including TM into the mainstream national health services and disease control interventions. Should contemporary Public Health (PH) engage with the other traditions of knowledge at all? Or do we work only with conventional MM and related public health measures are therefore questions to be answered.
With formally recognized TM knowledge systems being practiced in organized form in most countries (up to seven in contemporary India), any institutional approaches for HSR and policymaking must logically include consideration of TM. If we adopt a bottom-up perspective, then people's health-seeking behaviors and perceptions certainly require an understanding of TM. The reasons for continued utilization of TM for primary level care are generally considered to be due to their easy access, minimal side effects, low cost, and experience of effectiveness in conditions where MM tends to fail or has little to offer. Individuals and households practicing self-care are one commonly perceived role of TM. Further, TM medicines and practices such as acupuncture, yoga, and panchkarma, are increasingly being integrated with modern medical regimens even at secondary and tertiary levels. Thus, ignoring TM is not a rational option from the institutional or people's end of the health-care spectrum.
The WHO initiated the entry of TM into public health minimally in its Alma Ata documents of 1978, and the WHO TM program was established. In 2002, the WHO prepared the TM strategy 2002–2005 and updated it for 2014–2023 to guide countries in harnessing the potential of TM and regulate its products, practices, and practitioners. The recently inaugurated WHO Global Centre for TM (GCTM) in Jamnagar, Gujarat, as a knowledge center for TM opens up new possibilities for a comprehensive and ongoing inquiry into TM's various dimensions. “As part of the WHO's overall TM strategy, it has a strategic focus on evidence and learning, data and analytics, sustainability and equity, and innovation and technology to optimize the contribution of TM to global health and sustainable development. At the same time, respect for local heritage, resources, and rights is a guiding principle.”
It is noteworthy that TM should not be reduced to herbal/animal/mineral medicines or “products, practices, and practitioners” alone. Underlying these is a knowledge base. Each knowledge tradition has its own theories, ontologies and taxonomies, epistemology and methodologies for knowledge generation and assimilation, education and training of health-care providers, and regulation of the quality of services. Just as TM products and practices may be used as “complementary” to MM regimens in patient care, these concepts may provide “complementary” ideas for studying, organizing, and strengthening contemporary health systems. As “CIM medicine” operates in the clinical domain, an “integrative health system” (IHS) would integrate TM and MM as components of the health system. Specific national and local context would define the nature of relationship between TM and MM within an IHS.
| Need for Research|| |
However, TM, like MM, provides benefits and has limitations, and the implementation of IHS would face challenges. Hence, we need to examine several dimensions for incorporating TM into the purview of public health. It is to be hoped that the GCTM will provide the impetus for a wide-ranging inquiry into the potential of TM for PH. It must not restrict itself to testing the efficacy of TM products or their effectiveness in different communities, or public health interventions for awareness-raising and -providing clinical services at the population level. TM has a deeper role to play in PH, as argued by several scholars.,,,
Interactive transdisciplinary research across TM systems and MM on the principles of physiology and promotion of health; pathology and management of particular health problems; HSR and policy studies for an IHS at national, state, and local levels; understanding people's health-seeking behaviors and health perceptions in relation to TM, can lead to new approaches for sustainable and empowering health care. Evidence of efficacy needs to be generated in coherence with the knowledge principles. Distortions in TM products due to the changes in quality of raw materials or production processes, negative interactions of medicines across systems, and distortions in TM practice by health-care providers and households are likely to emerge and need to be tracked by the PH system.
TM's contribution can also be seen in its providing an imagination of epistemological holism since they integrally relate body, mind, and spirit to each other and to the natural and social environment. While “systems biology” is at the cutting edge of biomedicine today, taking physiology and pathology away from the reductionist Descartian roots of biomedicine, the notion of whole-body linkages is not yet adequately imbibed into biomedicine. Even more, PH interventions tend to remain medicalized. This was evident from the dominant virus-centered response to COVID-19 rather than building on the advances in multicausal epidemiology.
Generating service delivery institutional ecosystems for epistemic diversity (for instance through cross-referrals, colocation, integrative primary health care, and decentralized district knowledge resource centers) requires a creative and realistic engagement with institutional and professional cultural diversity. Besides the formal textual TM, linking the GCTM with documentation and validation of decentralized local health traditions of community healers and popular culture, and the certification of traditional healers and practices by the Quality Council of India are examples of creative possibilities.
Thus, defining the multiple roles of TM can contribute to designing locally and nationally appropriate health systems. Transdisciplinary research can lead to more holistic concepts of health, disease, and health care that are more attuned to the times and can empower people. The 21st century certainly requires us to make this paradigmatic shift toward pluralism in knowledge for public health, based on sound research for people-centered and not profit-motivated health care.
| References|| |
WHO. WHO Traditional Medicine Strategy 2014-2023. Geneva: WHO; 2013.
Valiathan MS. An Ayurvedic view of life. Curr Sci 2009;96:1186-92.
Priya R, Kurian CM. Regulating access and protecting traditional health knowledge through intellectual property rights? Issues from a holistic health systems perspective. Sci Technol Soc 2018;23:1-26.
Chaturvedi S, Kumar N, Tillu G, Patwardhan B. Research, biomedicine and Ayurveda: from evidence-based medicine to evidence-informed healthcare. Indian J Med Ethics 2021;6:301-5.
Porter JD, Mathpati MM, Payyappallimana U, Shankar D. Medicalisation and Ayurveda
: The need for pluralism and balance in global health systems. J Ayurveda Integr Med 2021;S0975-9476(21)00122-4. doi: 10.1016/j.jaim.2021.06.014.
Manohar PR. Clinical evidence in the tradition of Ayurveda
. In: Rastogi S, editor. Evidence-Based Practice in Complementary and Alternative Medicine. Berlin: Springer; 2012. p. 67-78.
Priya R, Sujatha V. AYUSH for COVID-19: Science or superstition? Indian J Public Health 2020;64:105-7.
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