文章基本信息

标题：A Public Health Agenda for Traditional, Complementary, and Alternative Medicine
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作者：Gerard Bodeker ; Fredi Kronenberg
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2002
卷号：92
期号：10
页码：1582-1591
语种：English
出版社：American Public Health Association
摘要：Traditional medicine (a term used here to denote the indigenous health traditions of the world) and complementary and alternative medicine (T/CAM) have, in the past 10 years, claimed an increasing share of the public’s awareness and the agenda of medical researchers. Studies have documented that about half the population of many industrialized countries now use T/CAM, and the proportion is as high as 80% in many developing countries. Most research has focused on clinical and experimental medicine (safety, efficacy, and mechanism of action) and regulatory issues, to the general neglect of public health dimensions. Public health research must consider social, cultural, political, and economic contexts to maximize the contribution of T/CAM to health care systems globally. THE GROWTH OF PUBLIC interest in and use of traditional medicine and complementary and alternative medicine (T/CAM) has been well documented. Almost half the population in many industrialized countries now regularly use some form of T/CAM (United States, 42% 1 ; Australia, 48% 2 ; France, 49% 3 ; Canada, 70% 4 ), and considerable use exists in many developing countries (China, 40%; Chile, 71%; Colombia, 40%; up to 80% in African countries 5, 6 ). Popular use of T/CAM has been accompanied by a growth in research and associated literature, with an increase in an evidence-based approach over the past decade. 7 In developing countries, where T/CAM has long been practiced both within and outside the dominant health care system, interest has been building over the past decade for a policy framework for T/CAM within national health care systems, and some guidelines have been created. 8, 9 The term “traditional medicine” is used here to denote the indigenous health traditions of the world; “complementary and alternative medicine” primarily refers to methods outside the biomedical mainstream, particularly in industrialized countries; and “conventional medicine” refers to “biomedicine” or modern medicine. While much of the momentum in the research and policy arenas has been driven by consumer demand or continued customary and traditional use, research and policy developments to date have tended to address clinical, regulatory, and supply-oriented issues, to the general neglect of wider public health dimensions. Typically, research has focused on efficacy, mechanisms of action and safety of complementary and traditional therapies. Educational and training efforts, particularly in industrialized countries, have involved medical students and conventional health care practitioners. 10– 12 Regulation of practitioners and guidelines for licensing and establishment of standards of practice and self-regulation have only recently been considered in industrialized countries. 13, 14 Only 25 of the 191 World Health Organization (WHO) member states have national policies on T/CAM. The newest WHO policy on T/CAM focuses attention on regulation as well as safety and efficacy issues. 6 A concerted effort by public health professionals to develop a comprehensive view of the field, to generate a targeted public health research agenda, and to set policy priorities is now needed to address the public health dimensions of the use of T/CAM. While it is not our intent to provide such an agenda, which will likely vary from country to country, we hope that this article may stimulate the development of a more comprehensive approach by research groups and funders.