Daniel F. Gallego-Perez, MD, recently joined other APHA members in attending the World Health Assembly in Geneva and shared the following report. He is chair-elect of APHA’s Integrative, Complementary and Traditional Health Practices Section, and a doctor of public health candidate at Boston University School of Public Health.

Daniel Gallego-PerezDuring the 72nd World Health Assembly held last month in Geneva, the World Health Organization organized a side event on the contributions of Traditional, Complementary and Integrative Medicine, or TCIM, to universal health coverage. The side event, held at WHO headquarters, featured presentations from several member states, the launching of the WHO Global Report on Traditional and Complementary Medicine, as well as working group discussions about TCIM´s potential to contribute to achieving universal health coverage goals.

All WHO regions were represented at the event, where high-level delegates from China, Cuba, Curacao, Ghana, India, Iran and Turkey, summarized their countries´ approaches to integrating TCIM into their corresponding national health care systems, particularly in the primary health care framework. In their presentations, several member states emphasized that TCIM was a national priority, manifested in the development and implementation of corresponding national policies and integration plans, already operational for several decades in many cases. Reported countries´ advances included the development of TCIM training programs, using both transversal approaches — integrating TCIM-competencies development across all health professions — as well as highly focused and specialized ones, such as the development of TCIM-related medical specialties and research-oriented programs.

Delegates reported that TCIM is a cornerstone of ongoing efforts to transform countries´ health care systems so that they effectively become people-centered, culturally relevant and holistic. Curacao´s minister for health, environment and nature, for example, emphasized the need to develop integrated approaches that include TCIM and wellness, where health interventions intersect with environmental ones, as well as those related to agriculture, food and nutrition, in order to achieve the Sustainable Development Goals. China reported ongoing efforts to increase access, in the context of universal health coverage, with the goal of making TCIM services available to every citizen in the country by 2020, both in the rural and urban environments, and to integrate TCIM in all aspects of medical care by 2030. All countries coincided in that TCIM offers untapped resources that need to be fully understood and adequately positioned so that while ensuring quality and safety, they contribute to achieve universal health coverage goals.

The 2019 WHO Global Report on Traditional and Complementary Medicine, launched at the event, is the third iteration. Its scope has considerably expanded, now covering aspects related to products, practices and practitioners. The report was presented by Edward Kelley, director of WHO’s Department of Service Delivery and Safety, and includes data from 179 of the 194 member states of WHO. The report confirms that TCIM is a global phenomenon of public health importance: 88% of member states acknowledged its use. There was no information available on the remaining 12%. The report highlights the consistent growth on the number of member states with national or state-level legal or regulatory framework on TCIM — 109, up from 79 in 2012; national TCIM policy — 98, up from 79 in 2012; national TCIM office — 107, up from 89 in 2012; national research institute — 75, up from 58 in 2005; regulation on herbal medicines — 124, up from 116 in 2012; regulation of providers — 78, up from 67 in 2012; and provision of coverage or reimbursement for TCIM services — 45, up from 37 in 2012. The number of countries that have a registration system for herbal medicines has increased to 125 from 109 in 2012, with 39 of them including herbal medicines in the national essential medications list, up from 25 in 2012; 110 countries reported using a pharmacopoeia that includes herbal medicines and 93 countries reported the use of monographs that include herbal medicines (2012 data). Kelley, during his intervention, added that TCIM should “ideally be an option offered by well-functioning, people-centered health systems that balances curative services with preventive care.”

Universal health coverage was a cross-cutting theme of the meeting, and the side event included working groups’ discussions about the potential contributions of TCIM toward achieving universal health coverage goals, identifying challenges and opportunities. It is important to note that the assembly approved document A72/70, that in preparation for the Sept. 23 United Nations High Level Meeting on Universal Health Coverage recommends that member states “…consider integrating, as appropriate, safe and evidence-based traditional and complementary medicine services within national and/or subnational health systems, particularly at the level of primary health care, according to national context and priorities.” Hopefully, the World Health Assembly’s recommendation, as well as the cited WHO report results and already existing evidence, would encourage member states to embrace TCIM’s potential contributions to health and well-being, and the achievement of the universal health coverage goals in the corresponding high-level meeting declaration.

Note: Recording and presentations of the side event will be available on the WHO website.