Think Global, Act Local: CAM's Role In Public Health
By Beth Sommers, PhD, MPH, LAc and Kristen Porter, MS, MAc, LAc
The American Public Health Association (APHA) held its annual meeting in Boston from November 2-6 last year. Hosting more than 12,500 attendees from the U.S. and around the world, the meeting brought together students and professional from all backgrounds.
APHA, founded in 1872, is the oldest and most diverse organization of public health professionals in the world. Goals of APHA include protecting all Americans and their communities from preventable, serious health threats. APHA also supports health promotion and disease prevention efforts, striving in particular to assure that preventive health services are universally accessible.
The theme of this year's annual meeting was Think Global. Act Local. Best practices were discussed in the context of the many themes of public health – environmental conservation, maternal and child health, epidemiology and statistics, policy-making, legal and ethical perspectives and, of course, integrative and complementary health care. APHA has been in the process of updating and refining its brand and image and its new descriptive tag line was introduced at the meeting: For science. For action. For health.
More than 1,000 scientific sessions were presented. Keynote speakers at the opening session included Mayor Thomas Menino of Boston, who discussed the effects of gun violence in communities. The lawyer who argued Roe v. Wade in the Supreme Court in 1973, Sarah Weddington, provided a rousing and sobering perspective on 40 years of women's health. The meeting's closing session focused on health of Native and Indigenous populations. Canada's Aboriginal population face numerous health and economic disparities. However, efforts of health advocates are addressing these inequities and striving to restore social justice for these groups. A video of the highlights of the annual meeting is available here: www.youtube.com/user/aphadc.
One of APHA's component groups is called the Alternative and Complementary Health Practices Special Interest Group (ACHP). Members of this group include many professionals and students involved in the practice or evaluation of Traditional Asian Medicine. Approximately 30 presentations on the spectrum of Traditional Asian Medicine – acupuncture, acupressure, herbal medicine, Qi gong, and the integration of acupuncture into biomedical care – were show-cased at this year's meeting.
ACHP's most significant presentation, called the Donna Feeley Memorial Lecture (named after a co-founder of the group), featured two speakers to address best practices around the world. These two speakers, Herbert Benson, MD and Jon Adams, PhD, addressed developing a vision for integrating healthy practices. Dr. Benson has developed the Relaxation Response over the past 40 years as a method of self-care that can reduce stress and result in health benefits. These benefits include normalizing blood pressure, reducing the level of stress hormones in the blood, and even affecting genetic changes that are associated with improved health. Dr. Adams, co-founder of the Network of Researchers in Public Health in CAM (NORPHCAM), discussed the importance of collaborative work that might involve acupuncturists, epidemiologists, and social scientists. He advocates research and evaluation that focus on healthcare as it is actually practiced. Although clinical trials continue to be important in our field, these type of studies often fail to address important issues such as acceptability or cost of interventions.
In a session entitled Integration of Alternative and Complementary Health Practices: Best Practices Around the World, speakers covered health care practices in China, Africa, India, Europe, Canada and the U.S. Acupuncture featured prominently in many of these countries as a form of healthcare that is acceptable and desirable by the public, as well as affordable to payers in the context of insurance plans or a country's healthcare budget.
Three speakers from Boston discussed integrated health practices at Boston Medical Center (Katherine Gergen Barnett MD), Dana-Farber Cancer Institute (Anne Doherty-Gilman MPH), and Pathways to Wellness (Demie Stathoplos MSW. MBA). Each of these institutions has a strong acupuncture component, and Dana-Farber and Pathways also offer Chinese Herbal Medicine. Hearing examples of the different ways in which acupuncture can be integrated provided audience members with a variety of options and perspectives about designing clinical programming that can meet the needs of patients.
Four presentations focused on the health benefits of Qi gong. In particular, speakers discussed the favorable impact of Qi gong practice for chronic pain management and for promoting sleep quality among people with chronic fatigue syndrome. The other two presentations described Qi gong practice as an approach to health maintenance. Presentations on acupuncture included specific studies to address effectiveness in treating COPD, chemotherapy-induced peripheral neuropathy, and in working with military veterans. For more information on all the presentations given, check the following site: https://apha.confex.com/apha/141am/webprogram/ACHP.html. By clicking on the name of an individual presentation, you can be linked to presenters' names and a brief abstract.
Eric Gebbie DrPH, MA and his colleagues discussed the integration of acupuncturists and other CAM providers into Oregon's state disaster volunteer program. Oregon's Public Health Division has massively increased the number of alternative and complementary health care practitioners in its official State Emergency Registry of Volunteers in Oregon. Over two years, a process of outreach and engagement through meetings, focus groups, and educational presentations increased the number of CAM practitioners from two acupuncturists and one naturopathic physician to 54 licensed acupuncturists, 38 naturopathic physicians and 40 chiropractors, among the highest proportion of participation per capita of licensees among all licensed health care professionals in Oregon. The role and value of acupuncture in addressing stress and related symptoms following natural disasters or other large-scale tragedies has been demonstrated by organizations such as Acupuncturists without Borders.
Sivarama Vinjamury MD and his colleagues presented a poster on the effectiveness and safety of using Traditional Chinese Medicine for patients diagnosed with Alzheimer's disease. The group conducted a literature search of randomized controlled trials (RTCs) on acupuncture and Chinese Herbal Medicine through November 2012 using PubMed, Google Scholar and VIP. Safety and adverse event reports were also reviewed. Although few studies were identified in the literature and the quality of the articles varied, favorable results were noted in one RCT that examined the effects of acupuncture on patients' ability to perform activities of daily living. Traditional Chinese Herbs were also assessed for their clinical efficacy with limited favorable evidence in seven studies.
Although APHA meetings have included studies on acupuncture for over a dozen years, this year's gathering specifically addressed the integration of acupuncture into conventional healthcare. Many of the speakers describing their institutions' experience with offering integrative care were not acupuncturists, but came from other health disciplines that are now more closely aligned with acupuncture providers. This seems like a significant step forward in the trajectory of our profession's development in the U.S. Namely, our public health colleagues are more clearly recognizing the value of acupuncture in addressing a myriad of conditions affecting the mind, body and spirit. Such a shift in perception can only come about because of the work being done by acupuncturists throughout the country, whether they are working in individual clinics, for healthcare systems such as hospitals or community clinics, or in the field of education and training. Our collective efforts have definitely resulted in a sea-change in how acupuncture is appreciated and valued by our colleagues in other health-related professions. Although acupuncture is not yet fully integrated into the US healthcare system, this integration is more within our reach than ever before.
APHA's next annual meeting will be held November 15 to 19 2014 in New Orleans. Its theme will be Healthography: How where you live affects your health and wellbeing.
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