Future challenges for EU health policy in the framework of CAM
by Ton Nicolai MD
Spokesman and Co-ordinator of EUROCAM
EUROCAM, ‘CAM 2020: The contribution of Complementary and Alternative Medicine to sustainable healthcare in Europe,’ provides information about Complementary and Alternative Medicine (CAM), scoping its current practice and availability as well as its potential future role across the EU. It also highlights a number of priority policy action areas to enable CAM to fulfil its significant potential to contribute to the healthcare of citizens throughout the EU. EUROCAM, the network of European CAM patients’ organisations, medical doctors practising CAM and trained CAM practitioners, is aimed at promoting the contribution of CAM to better health in Europe.A new publication from
The Organisation for Economic Co-operation and Development (OECD) notes that only 3% of health budgets are spent on prevention and promotion, leading to calls for a paradigm shift away from treating illness and towards helping individuals to make healthier choices and take greater responsibility for their own health.1 Clearly, public policy should support, stimulate and enhance each individual’s inherent wellness and healing capacities since this provides the most powerful force we have for maintaining health and productivity when well, and for enhancing recovery and well-being when ill.
Prevention is an area where professionals in the field of Complementary and Alternative Medicine (CAM) can provide added value. At the level of primary prevention, CAM modalities can be effective in health promotion, including lifestyle counselling, dietary guidance, stress reduction techniques, interventions to improve sleep quality, and use of nutritional and herbal supplements for health promotion. At the level of secondary prevention, stress management and nutritional supplementation can reduce risk factors for chronic disease. At the level of tertiary prevention, the full range of CAM modalities supports goals such as pain management, stress relief, disease management, and risk reduction. 2
The CAM model also offers financial sustainability by encouraging disease prevention via less costly interventions that potentially lead to long lasting outcomes of treatment. There is a growing evidence to show that the introduction of CAM into primary care not only improves citizens’ health but can potentially offer short and long-term savings in healthcare costs.3 With its focus on supporting patient literacy and empowerment and maintaining health, integration of CAM’s holistic methodologies into primary care can have long-term benefits for patients’ and public health in general.
Healthy ageing - healthy workforce
EU citizens are living longer and having to work for more years to pay for their support in later life. CAM can play an important role in helping citizens achieve optimum health in later life. Surveys show that in early middle age increasing numbers of citizens regularly use CAM as they become aware of the need to stay healthy and prevent the onset of chronic diseases associated with ageing such as arthritis and circulatory disorders. They seek to take care of their health in a positive way developing the ability to make sound health decisions and lifestyle changes and taking responsibility for their health. In this they are frequently aided and supported by CAM products and practices that they integrate into their health care. Unfortunately, because most CAM is currently unavailable through healthcare systems it is only those who can afford it that can access it. To help enable the maintenance of health through a longer working life and into old age, serious consideration must be given to WHO’s recommendation to integrate CAM into the healthcare systems of Member States. 4
Patient quality of life
One out of two EU citizens uses CAM in one form or another5 as part of their healthcare, whether as a complement or an alternative to conventional care. Citizens use CAM because they perceive and experience this form of treatment to be holistic and empowering and less likely to cause adverse reactions than conventional medicine. One area in which there is a high percentage of CAM use is by patients with cancer. There is a growing body of evidence to show that mindfulness-based stress reduction helps patients deal with the stress of cancer and its associated treatments and that acupuncture can help reduce the nausea related to chemotherapy. Even where there is little or no evidence for some types of CAM, many people with cancer say they gain a lot of benefit from using them.
Both the WHO and the EU have identified antimicrobial resistance (AMR) as a major crisis facing the health systems of all countries worldwide. Widespread use of antibiotics in the animal food industry has been a major contributor to the rise in resistance. The pharmaceutical industry is struggling to find new antibiotics to replace the failing older products. The European Centre for Disease Prevention and Control estimates that AMR results each year in 25,000 deaths and related costs of over €1.5 billion in healthcare expenses and productivity losses in Europe. In the light of this crisis and in order to reduce the use of antibiotics, there is sufficient evidence and practical experience that some CAM modalities can contribute to the greater efforts needed to encourage healthy lifestyles reducing the need for antibiotic use. In addition, increasing evidence suggests that herbal, anthroposophic and homeopathic medicine can offer effective alternatives to antibiotics. They must therefore be seriously considered and investigated by the EU, both for human and animal health.
Sustaining the EU health workforce
There are some 300,000 CAM providers working in the EU. Most of them are currently practitioners or medical doctors working outside national health systems in the private sector. At the same time, there are predictions of a looming crisis in the provision of sufficient EU healthcare providers to meet future needs. In these circumstances, the health agenda has to change to emphasise prevention and the means to achieve healthy ageing. This can be delivered with the input from a ready-made CAM workforce able to deliver relevant messages and practices that offer at least a partial solution to the problem.
CAM is consistent with the priorities of the current EU Health Strategy, in particular in relation to reducing healthcare costs, promoting healthy ageing, reducing antimicrobial resistance and supporting innovative health systems. CAM practices inherently promote health literacy and healthy lifestyle habits, and are often used for the management of chronic diseases. CAM thus has a role to play in building economic prosperity by enhancing health in the work place and cutting illness-related absences. In fact, CAM is the outstanding major, low-cost innovation available in Europe. It is no exaggeration to say that CAM’s time has come as it has the potential to enable public health systems across the EU to attain the goals of the European health policy ‘Investing in Health’ and thus support sustainable healthcare systems.
2 Katz, DL & Ali A (2009) Preventive medicine, integrative medicine & the health of the public. IOM Summit on Integrative Medicine and the Health of the Public, USA. http://www.nap.edu/openbook.php?record_id=12668. Accessed 20/04/14.
3 Herman PM, Poindexter BL, Witt CM, et al. (2012) Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations. BMJ Open;2:e001046.
4 WHO (2013) Traditional Medicine Strategy: 2014-2023, WHO Press, Geneva, Switzerland, ISBN 978 92 4 150609 0. Approved at the 67th session of the World Health Assembly of 24 May 2014 (WHA 67.18).