TRADITIONAL MEDICINE
AND GLOBAL HEALTH
An Introduction
HERB SHOP IN PERU
UNANI CUPPING IN PAKISTAN
INTERIOR OF A NATIVE AMERICAN SWEAT
LODGE. . . AT VA HOSPITAL IN UTAH
Objectives:
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Define Traditional Medicine (TM)
Explain TM’s relevance to global health
Review WHO’s Position on TM
Case Studies: Successes and Failures
I. What is Traditional Medicine (TM)?
Traditional Medicine (TM):
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“long-standing indigenous systems of health care
found in developing countries and among the
indigenous populations of industrialized countries”
(Bodeker 2006)
sometimes called ethnomedicine since many
systems or practices pertain(ed) to a specific
cultural group
TM, CAM, or TCAM?
Q: Is moxa an alternative tx?
A: location, location, location

TM practiced outside its area
of origin is considered a type
of CAM (Complementary &
Alternative Medicine).
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The globalization of TM has
made the terms TM/CAM and
TCAM popular.

Class Focus: TM in the
Global South.
Traditional Medicine Characteristics
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Vitalistic and humoral
Holistic and individualistic approach to
pathology
Health as balance of body, mind, spirit, society
Focuses on healing illness
Increasingly influenced by biomedical model
and perspectives
What are some similarities and differences
compared to biomedicine?
Typology of TM Providers*
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Herbalists
Manual Practitioners
Bonesetters
[Traditional Birth Attendants]
Spiritual Practitioners
*Practitioners vary system by system
TM’s Role Varies Greatly
Health Sectors
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Popular
Professional
Folk
National Health Policy
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Integrative
Inclusive
Tolerant
Traditional Chinese Medicine (TCM) in China
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Uses modalities such as
herbs, acupunture, tui-na,
and qi-gong to maintain
yin/yang balance and to
regulate qi
Fully recognized in the
professional sector; fully
integrative government
policy
Graduates of TCM colleges
licensed as TCM
physicians
Ayurvedic Medicine in India
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Uses herbs, yoga, massage,
meditation, breathing tx,
and panchakarma to
maintain a bodily balance
of vata, pitta, and kapha.
Recognized in professional
sector as part of an
inclusive health policy
Licensure as ayurvedic
physicians
Ghanaian Traditional Medicine
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Uses herbs, counseling,
and shamanistic-type
practices to maintain health
as harmony of body, mind,
spiritual world, and society
Officially recognized in
professional sector by
government, whose policy
has moved from tolerant to
relatively inclusive (in
theory)
Registration of healers
Global Trend: Professionalization, Research, Policy
Development
Traditional Thai Medicine (TTM):
From Outlaw to In-Patient Care
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Practices range from massage
and herbal medicine to shamans
and spiritual healers.
Outlawed in the 1930’s,
relegated to folk/popular sectors
Elements recognized in the 80’s
as having merit
Today, TTM herbal medicine
and massage are licensed,
regulated, and included in
national health policy, and taught
at Mahidol University, among
other schools
The Rigors of Research!
II. Why is TM relevant to GH?
Five Key Reasons
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A. Utilization & Access
B. Potential Impact
C. Workforce Expansion
D. Cultural Competence
E. Dollars & DALYs
A. High Utilization & Access Patterns*
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For Example:
 40%
of health care in
China is TCM
 80% of Sub-Saharan
Africans use TM
 Over 70% of Chileans
use TM of some sort
 Over 60% of rural
Indians use TM
*data and graph from WHO Traditional Medicine
Strategy 2002-2005
Factors Underlying Utilization
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Availability
Cost
Medical Pluralism
Health Belief Models
B. Impact of TM Models and Practices
Potential to Benefit
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Ugandan herbs for herpes
zoster in the HIV-infected
as effective as acyclovir
Aqueous extract of fennel
can help to relieve intraocular pressure
Polysaccharides in several
Chinese herbs reduce side
effects of chemotherapy
and decrease tumor size
Potential to Harm
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HIV-positive Ugandans
using TM are twice as
likely to quit ARV’s within
2 years
30-40% of Nepalese who
use TM eye ointments
suffered corneal ulceration
Flavonoids in Qing Pi
might inhibit effectiveness
of Tamoxifen
B. Impact of TM Models and Practices
Potential to Benefit
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Ugandan herbs for herpes
zoster in the HIV-infected
as effective as acyclovir
Aqueous extract of fennel
can help to relieve intraocular pressure
Polysaccharides in several
Chinese herbs reduce side
effects of chemotherapy
and decrease tumor size
Potential to Harm
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HIV-positive Ugandans
using TM are twice as
likely to quit ARV’s within
2 years
30-40% of Nepalese who
use TM eye ointments
suffered corneal ulceration
Flavonoids in Qing Pi
might inhibit effectiveness
of Tamoxifen
C. Workforce Expansion
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Traditional Healers can help to
fill the workforce shortage (2
million+ HCP’s)
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HIV/AIDS prevention
Health promotion , health care
provision, lay mental health
counseling
Curbing harmful TM practices,
encouraging beneficial ones
Clinic referrals
Crucial points:
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Healers can help or harm!
Programs can succeed or fail
D. Culturally Competent Engagement
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Health-seeking
behavior is partially
based on EMs
Ignorance or
insensitivity may
impact success.
Examples:
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hot/cold dichotomies
cerebral malaria
Biomedical tx for
proximate causes TM for
efficient causes
Call it E. Coli or “Damp Heat,”
it’s still the runs . . .
E. Dollars & DALYs
III. What is WHO’s Position on
TM?
WHO &TM: A Brief History
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1948 WHO’s Constitution defines health as “a state of
complete physical, mental and social wellbeing, and not
merely the absence of disease”
1978: The Alma Ata (Kazakhstan) Declaration on primary
care includes “traditional practitioners as needed” and noted
that they should be suitably trained
2008: Beijing Declaration on TM
 TM, primary care, and MDGs as interrelated
 Varying national needs and circumstances
 Importance of education, communication, and collaboration
WHO’s: Traditional Medicine Strategy,
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Develop sound policy on licensing, regulation, and incorporation
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Ensure safety, efficacy, and quality for utilization and
surveillance
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Provide equitable access to beneficial TM to protect health,
promote sustainability, and protect rights
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Establish rational use for patients, providers, and health care
collaboration between TM and biomedicine
Dr. Chan Endorses TM . . . But
Makes An Important Point
Dr. Chan’s Key Point:
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“Traditional medicine has much to offer, but it
cannot always substitute for access to highly
effective modern drugs and emergency measures . .
. . This is not a criticism of traditional medicine.
This is a failure of health systems in many
countries to deliver effective interventions to those
in greatest need, on an adequate scale.”
The Challenges Global Health
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Utilize the benefits that TM can provide
Exploit the potential of TM providers to meet other
primary care needs
Devise rational use strategies to maximize
beneficence and minimize maleficence
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19 WHO Collaborating Centers, including
NCCAM and College of Pharmacy at UI Chicago
IV. TM Successes and Failures
Success: FRLTH--Home Herbal Gardens
in South India
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Foundation for Revitalization of
Local Health Traditions in
Bangalore
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Researches local herbs for common
“OTC” conditions, helps rural
families and communities to set up
home health gardens (herbs and
fruits), and trains in appropriate use
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50-80% decline in health care costs
among participating families
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Importance: families pay 70-85% of
healthcare costs, a significant cause
of rural indebtedness
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190,000 gardens now in use
Success: THETA Uganda--HIV/AIDS Education
& Collaboration
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Traditional Healers and Modern
Practitioners Together Against
AIDS and Other Diseases
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Collaborates with MoH and
research universities to studyTM
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Has trained +/- 3000 healers
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Communities with THETA
trained healers have higher
levels of knowledge about
HIV/AIDS
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Traditional healer referral rates
to biomedical doctors increase
by 90%
But failures provide a cautionary tale . . .
Ugandan Male with Lymphoma
Sought
traditional
healer.
Confused by
biomedical
diagnosis.
Besides, he
had no money
to pay for
chemotherapy
since free
drugs were
unavailable at
the time.
Treated by a Traditional Healer
The healer
injected the
nodes until
necrotic.
Healer did not
refer to a
biomedical
provider; nor
did he
understand
malignancy.
Lymphoma
spread.
I met this man
when he was
dying in
hospital .
The Bottom Line
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Depending on the circumstances, TM is both an
important asset of culturally competent global
healthcare delivery and a symptom of failure and
structural violence.
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TM is a tool in a multi-disciplinary GH arsenal
Avoid ignorant skepticism & wishful optimism
TM and biomedicine: not an either/or scenario
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