Traditional medicine: friend or foe in the quest to achieve adequate universal health?

Image Credit: United Nations Department of Global Communications

The push for the attainment of a healthy global population is not a recent one. Although interest in the topic waxes and wanes in the political arena, it is clear that since the formation of organisations such as the World Health Organisation (WHO), the idea of improving health and health equity has been a top concern for many world leaders. However, the move from paper to practice of some policies—such as the Millennium Development Goals (MDGs) or the Sustainable Development Goals (SDGs)—has been met with failure or insurmountable difficulties. 

Until recently, the topic of health evoked pictures of nurses, doctors, and hospital beds. With the rising incidence of obesity and obesity-related complications during the COVID-19 pandemic, and with the awareness of poor mental health states of public figures, there has been a push towards preventative, rather than hospital-based, health policies. Rising temperatures, floods, and other natural disasters have affected the lives and wellbeing of different groups of people. This has brought the need for accountability of all nations to the forefront in keeping our global home—Earth—healthy, while ensuring the wellbeing of its inhabitants as well.

Despite the move towards preventative policies, the inequitable distribution of resources, poor accessibility within remote regions, and the spread of emerging diseases, indicate that prevention strategies may not be adequate as the sole solution. The use, cost, and distribution of biomedical measures in the form of pharmaceutical treatments, diagnostic tests, and vaccines still poses challenges for many decision makers. The need to establish an ethical balance in drug choice and investigations to certain diseases—based on either the human right to health or the cost-effectiveness of orthodox treatment—has led to the establishment of protocols and guidelines by institutions such as the National Institute for Health Care and Excellence (NICE). However, the myopic focus on orthodox treatments has led to the neglect of potentially effective measures such as traditional medicine. 

What are the origins of traditional medicine?

“Traditional medicine refers to knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, used in the maintenance of health and in the prevention, diagnosis, improvement, or treatment of physical and mental illness”—WHO

The coinage of hospital-based medicine practices as orthodox, modern, or even conventional, lends itself to the idea that other practices may be outdated or unconventional. History, however, tells us differently.

Prior to colonisation and industrialisation, non-conventional medicine or traditional medicine were the backbone of the health system among African, Native American, and Asian tribes. Traditional healers held power and authority in their communities and were responsible for advising Kings about health matters—similar to the Chief of Medical Officers and Health Ministers today. Although most defenders of colonialism espouse its positive impacts on education and civilisation of colonies, there were negative effects on the indigenous knowledge system—especially on indigenous medicine. The introduction of new systems, and in some cases an outright ban of traditional medicine, led to the undermining and stigmatisation of the indigenous health care system. This may have contributed to the preference of (supposedly ‘superior’) orthodox medicine across the globe, and the side-lining of traditional medicine.

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Ginger root

From 1999 to 2005, this perception was gradually rectified with the inception of the WHO Traditional Medicine Strategy. It introduced a formal recognition for the need of integration of traditional and complementary health practices as part of essential health services in the Universal Health Coverage objective. Furthermore, the Astana declaration in 2018 placed equal emphasis on the demand for the use of traditional and scientific methods in achieving success in primary healthcare. Although the majority of countries signed this declaration, a large implementation gap at the country and community level remained. The 2019 WHO report on Traditional Medicine revealed that most countries had made very little progress due to a lack of research when making decisions and developing policies. 

Even now, modern practitioners of allopathic medicine view most herbal medicine practitioners with high levels of distrust, portraying them as charlatans and money-grabbers. In some cases, these views have not been without legitimate cause, and the scepticism may stem from use of poorly conducted trials or biased reporting of the efficacy of some traditional medicine. However, there is evidence to demonstrate a growing demand for traditional medicine in African, Asian, and Western countries. Treatment would involve a variety of ailments, ranging from high fever in children in Ghana to convulsions in rural Tanzania. 

Why is there a growing demand for traditional medicine?

Despite the reluctance to deviate from orthodox medicine, the growing demand and acceptance of traditional, complementary, and alternative medication cannot be ignored. In Australia, France, and Canada, an estimated 40-70% of the population uses traditional medicine. Additionally, 40% of physicians in the United Kingdom make alternative referrals. A portion of the population also combines orthodox and traditional medicine when treating various diseases, unbeknownst to their healthcare providers. This may lead to adverse pharmacological effects such as excessive bleeding due to concurrent use of warfarin and ginkgo biloba.

There is also increasing evidence for the efficacy of traditional medications in the management of many conditions. For instance, ginger has been proven to be more effective than placebo in controlling nausea and vomiting during pregnancy. Besides this, it has also been shown to be as effective as the commonly used antiemetics, but with fewer side-effects of drowsiness. A study performed in Nigerian villages indicated a reduction in the Anopheles larvae population after their habitat was treated with Neem seed powder, thus controlling the malarial vectors. Although scarce in nature, scientific evidence on the effectiveness of such traditional treatments can change the public health policies, especially in resource settings where formally recognised antiemetics or insecticides are limited. In high-income countries (HICs), the reasoning behind choosing traditional medicine is markedly different than in low- and middle-income countries (LMICs). Where people in LMICs might not have a choice, people in HICs choose to use traditional medicine as they might be afraid of the adverse effects of pharmaceutical drugs. Additionally, they recognise the increased prevalence of chronic illnesses and might relate this to the type of healthcare those people receive. Populations in HICs also have better access to health information, thereby allowing them to question their prescribed drugs.

Image Credit: Wikimedia Commons

Neem seed

In formerly colonised regions like Africa, India, and other LMICs, most people rely on traditional medicine due to lack of and high costs of orthodox treatments. Others might use it as a last resort in their search for a solution to long standing ailments which have not been cured despite several visits to modern practitioners. For most, however, the preference for traditional medicine is tied to their lifestyle, their prevailing belief of their sickness having supernatural causes, or even their innate distrust in modern medicine as being the ‘white man’s’ medicine.

In my opinion, traditional and complementary health practices are not the enemy in the quest to achieve adequate universal health. It is time to demystify traditional medicine and acknowledge the shortcomings of orthodox medicine. Proper education and integration will also help to alleviate adverse effects of drug-herb interactions that are common among those in LMICs. This push to normalise, integrate, and standardise traditional medicine use in our healthcare system will not be an easy one. It is necessary to open up a dialogue about the formal tradition of healers, the inclusion of courses on traditional medicine in healthcare sectors, and the funding and commissioning of large-scale studies on the efficacy of such treatments. Additionally, formal bodies and legal frameworks should be set up to monitor and penalise illegitimate healers. With the growing dilemma of either using cost-effective health practices in the face of scarce resources, or basing health policies solely on the right to health, traditional medicine may be the solution we need.