The EPHA’s Monika Kosinska and Sascha Marschang argue that complementary and alternative medicine offer a win-win approach towards better healthcare...
The term ‘Complementary and Alternative Medicine’ – commonly abbreviated to CAM – encompasses a number of disciplines. These include methods as diverse as anthroposophic medicine, homeopathy, manual therapies (for example chiropractic therapies and osteopathy), naturopathy, herbal medicine, acupuncture, shiatsu and traditional Chinese medicine. Whilst treatments and philosophies may differ in traditions, values, terminologies and definitions, what unites them as ‘CAM methods’ is their view of health as a dynamic system shaped by the interactions between body, mind, spirit and the living environment. Patients are increasingly turning to CAM therapies but little is being done by health systems to understand how CAM can contribute to wellbeing, sustainability and cost-saving. For patients, CAM is already a popular consumer choice. Many of its methods are now well-established, largely because they tend to be viewed as relatively risk-free. CAM is used both alongside – and, in some cases, as a fully-fledged alternative to – conventional medicine, producing high levels of user satisfaction overall. The personal approach taken by CAM providers and the individualised treatments that can be devised correspond well with patients’ growing desire not to be treated as a number or disease label, and to take more responsibility for their own health. The renewed political interest at the EU level in exploring CAM’s potential must be viewed in relation to Europe’s overstrained health systems, as marked by budget cuts, professional shortages and increasing patient numbers and expectations. Challenged by a rise in chronic and non-communicable diseases, an ageing population, and various issues related to lifestyle factors, the paradigm in which Europe aims to provide adequate healthcare for everyone living in the continent is shifting. Furthermore, due to socioeconomic pressures arising from the ongoing crisis, mental health issues are becoming all the more common. The effects of austerity are increasing health inequalities and triggering great stress, uncertainty and fear. In other words, the demands on health systems are continually increasing while their budgets are drying up. As policymakers work to devise sustainable models, CAM may have a useful role to play. More than half of Europeans have some experience of CAM and up to 400,000 professionals offer a range of CAM modalities across the EU. Yet in spite of substantial supply and demand, a number of barriers to access remain. CAM is delivered predominantly through private practice – out-of-pocket payments are required that, as in the case of traditional private healthcare, restrict the potential market to those users who can afford to pay. The result of such a barrier is reflected in the profile of CAM users, who tend to be working professionals. Furthermore, questions remain, particularly within the health sector, about the safety and efficacy of CAM therapies and methods. Such barriers should be central to the discussion about the role of CAM in the development of sustainable European health systems.
The legal vacuum
At both European and national level, fuelled by a lack of harmonisation and resulting uncertainties, CAM faces an indistinct regulator y and political framework. This complicates issues such as access to CAM therapies, the professional mobility of practitioners, safety and efficacy requirements and the inclusion of CAM practitioners in the health professional community.
In EU policymaking, engagement with CAM has been rather clumsy and, until now, CAM has played at best a marginal role in EU health programmes and research projects. However, the recently concluded three year CAMbrella project, financed under the 7th Research Framework Programme (FP7) of the European Commission, took stock of the diversity of stakeholders, evaluated the situation and the potential of the sector and determined the obstacles and knowledge gaps that are impeding CAM research. The project produced an ambitious roadmap for European CAM research, aimed at identifying ways to generate knowledge in priority areas, such as analysis of the attitude of patients and health providers towards CAM and the production of comparative data on clinical outcomes, safety and adverse effects. There is a clear and present need to accurately measure CAM provision and regulation, address issues pertaining to professional accreditation and licensing, and encourage high educational and quality standards in the EU. While the debate about the evident benefits of CAM is ongoing, it is hoped that the recommendations of the CAMbrella roadmap will result in concrete research projects targeted at overcoming the gaps in awareness and acceptance. Through CAMbrella, the CAM community has urged political decision-makers to consider CAM as an integral part of the solution to the current crisis in healthcare. Where provided and regulated effectively, CAM can harness the provisions of the single market to help enhance equitable access to treatments and products. The achievement of these aims will require a great deal of networking and advocacy but may ultimately produce benefits for European health systems. The diversity of the CAM sector, combined with its heterogeneous regulatory situation, poses one of the biggest challenges. On the one hand, European and national decision-makers demand a unified CAM community that speaks with one voice. On the other hand, this is marred by marked differences in national legal frameworks. Moreover, CAM providers fall into a number of different professional categories. For example, some treatments are offered by medical doctors trained in certain CAM methods, whereas others are provided by non-medically trained practitioners who use a different approach towards their patients. While some are able to take advantage of professional mobility across Europe, others see their existence endangered by changes in EU legislation, such as those rules related to the recognition of professional qualifications or the regulation of certain herbal products. The public health community cannot afford to be complacent about CAM. CAM values are in line with one of the principal public health aims: to bring about a paradigm shift from treatment to prevention. From a public health perspective, it is as important to know what combinations of factors help people stay healthy as it is to understand what makes them ill. The discourse of health at a European level increasingly emphasises the importance of patient empowerment and self-responsibility, as well as tailored treatments and the
value of health literacy. CAM’s holistic life-course approach and its focus on prevention and the individual can contribute to the achievement of fundamental health system objectives, such as reducing the number and length of hospital stays and doctors’ consultations by preventing people from falling ill in the first place. In summary, CAM opens up a range of benefits based on alternative treatments, in particular disease prevention, the promotion of healthy lifestyles and wellbeing, and cost-effectiveness. Innovative, fresh approaches to healthcare should be taken more seriously if we really want to devise health systems capable of meeting people’s evolving needs and expectations.
Monika Kosinska Secretary General
Sascha Marschang Policy Coordinator for Health Systems
European Public Health Alliance (EPHA) www.epha.org