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Alternative and Complementary Health Practices
Section Newsletter
Fall 2010

Message from the Co-Chairs of ACHP

 

Greetings to Members and Friends!

The theme of change is reflected in the season and in the national debate on health care. We find ourselves at a unique time in the journey of complementary and integrative care; seeing many positive indications that comprehensive approaches are becoming adopted throughout the country. Although the jury is still deliberating on the outcome, we can play a pivotal role in influencing the national discourse and direction. Friends at the Integrated Healthcare Policy Consortium hosted a working conference of major integrative health care stakeholders, for briefing and strategy sessions on implementation of the Patient Protection and Affordable Care Act of 2010 and further health care reform. Because this will occur after we “go to press” we don’t have details yet, but will be sharing more of this information with you.

We hope to see many of you at the Annual mMeting in Denver in November. Besides a number of cutting-edge presentations and a program designed to inform and inspire, our Business Meeting on Monday evening will give attendees an opportunity to discuss concerns such as our SPIG’s role in APHA policy-making and the ongoing development of our SPIG. One item on the agenda will be producing a directory of our members, including areas of expertise.


Come and share in the APHA experience in Denver!


Rick Harvey

Beth Sommers

Message from APHA

 

Message from APHA

From Nov. 6-10, 2010, join us in Denver  for the APHA 138th Annual Meeting and Exposition. More than 1,000 cutting edge scientific sessions will be presented by public health researchers, academicians, policy-makers and practitioners on the most current public health issues facing the nation today. For more information about the Annual Meeting, visit www.apha.org/meetings.

Our section will have a strong presence at the meeting. View the sessions sponsored by our section by visiting the interactive Online Program. Search the program using keyword, author name or date. Don’t forget to stop by our new booth in the Section and SPIG pavilion (booth 1370) in the Public Health Expo next to Everything APHA.

Welcome

Below is a welcoming letter that APHA will send to new members of our ACHP SPIG. Please also pass this on to your friends at APHA and encourage them to join ACHP. Let's make THIS the year that our SPIG becomes a SECTION!

 

Welcome to our group!

On behalf of Co-Chairs Richard Harvey and myself, we want to take this opportunity to greet you and introduce you to the work of the Alternative and Complementary Health Practices (ACHP) group.

Our members represent a vibrant and diverse group of academics, researchers, providers and practitioners, consumers, students, policy-makers and analysts, and advocacy specialists. We represent every aspect of complementary and integrative health and medicine including:

  • mind-body approaches

  • traditional and indigenous medicine

  • nutritional science and practice

  • energy medicine

  • body-based programs

  • movement therapies

The title of our group “Alternative and Complementary Health Practices” emphasizes that we support the full range of activities elaborated by NIH’s National Center for Complementary and Alternative Medicine, with a full appreciation of self-care and lifestyle approaches that individuals can take to maximize their health and well-being.

As a new member of ACHP you can expect to:

  • be inspired by the vision, creativity, and talent of your colleagues.

  • inspire other members with your work and perspective.

We look forward to meeting you and hearing from you in our ACHP Newsletter, which is available via the APHA website. Together, we can work toward the goal of making health care that includes wellness a right, not a privilege.

In health,

Richard Harvey, PhD

Beth Sommers PhD, MPH, LAc

Co-Chairs (ACHP)


Yoga as a Complementary Therapy for Depression

 

Public Health and Yoga

In this issue you’ll have the pleasure of reading two articles written by members Manoj Sharma and Brandon Eggleston:

 

Yoga as a Complementary Therapy for Depression

 

By  Manoj Sharma, MBBS, CHES, PhD

Professor, Health Promotion & Education & Public Health, University of Cincinnati

 

& Purvi Mehta, MS

Graduate Research & Teaching Assistant, Health Promotion & Education, University of Cincinnati


In 2006, the Behavioral Risk Factor Surveillance System (BRFSS) found that the prevalence of current depressive symptoms in the general population was 8.7 percent and the lifetime diagnosis of depression was 15.7 percent, making it a common illness (Strine et al, 2008). While the specific cause of depression is not known, a range of factors have been implicated. These include genetics, chemical imbalance, hormonal factors, stress, and/or medical illness(es). The treatment of depression varies from use of antidepressants, psychotherapy or a combination of the two. Often times, individuals suffering from depression try complementary forms of treatment due to the side effects of antidepressants, a lack of positive results, or willingness to experiment (Pilkington, Kirkwood, Rampes, & Richardson, 2005). It has been found that approximately 75 percent of individuals suffering from depression have tried alternative forms of treatment.

 

One alternative form of treatment is yoga. Yoga is an ancient system of physical and psychic practice that originated during the Indus Valley civilization in South Asia. The first codified record of this methodology appeared in the Yoga Sutra of Patanjali around 3rd or 4th Century BC (Singh, 1983). The system consists of eight-fold path or asthangayoga. In contemporary literature, yoga has been defined in several ways and a more acceptable modern interpretation implies the systematic application of techniques to promote harmony in the human body, mind, and environment (Maharishi, 1992). The traditional practice of yoga was quite rigorous and arduous and entailed lifelong devoted practice and adherence to strict austerities. Today many schools of yoga have simplified the techniques making them more suitable for users in different walks of life. The eight conventional steps of asthangayoga consist of yama (rules for living in society), niyama (self-restraining rules), asana (low physical impact postures), pranayama (breathing techniques), pratyahara (detachment of mind from the senses), dharana (concentration), dhyana (meditation, and samadhi (union with super consciousness). Different schools of yoga utilize all or some of the above practice steps.

 

There are a total 18 studies between 2005 and June 2010 that have examined the relationship of yoga on depression. We will be exploring the results of whether yoga works for depression in our paper entitled, “Yoga as a complementary therapy for clinical depression” to be presented in Session 2048 on Nov. 7, 2010 of the 138th Annual Meeting of APHA to be held in Denver (Sharma, 2010). All interested are cordially invited to attend the session.

 

References

Maharishi, Y. V. (1992). Journey of consciousness. New Delhi, India: Macmillan India Limited.


Singh, K. (1983). Religions of India. pp. 76-78. New Delhi: Clarion Books.


Strine, T. W., Mokdad, A. H., Balluz, L. S., Gonzalez, O., Crider, R., Berry, J. T., & Kroenke, K. (2008). Depression and anxiety in the United States: Findings from the 2006 Behavioral Risk Factor Surveillance System. Psychiatric Services, 59(12), 1383-1390.


Pilkington, K., Kirkwood, G., Rampes, H., & Richardson, J. (2005). Yoga for depression: The research evidence. Journal of Affective Disorders, 89(1-3), 13-24.


Sharma, M. (2010). Yoga as a complementary therapy for clinical depression. Published abstract in the Proceedings of the American Public Health Association's Annual Meeting, USA, 138, Session 2048. (Abstract available from: http://apha.confex.com/apha/138am/webprogram/Paper214049.html )

Worksite Wellness Yoga

 

Worksite Wellness Yoga

 

Brandon Eggleston, PhD, CHES

Individuals have practiced yoga for thousands of years because of its many health benefits. In recent years, yoga has become a popular physical activity and stress management technique, with more than 20 million individuals practicing in the United States. However, even with the growth in popularity, there are several factors that keep individuals from beginning to practice or maintaining their practice. The primary factor keeping individuals from attending yoga classes/practicing yoga (similar to other forms of physical activity) is that individuals have difficulty finding time in their schedule to practice yoga. Other barriers that prevent individuals from practicing yoga include the location of the yoga studio, cost of the yoga class, and the time of day that yoga classes are offered. A solution that many wellness managers have implemented to is to offer free (or discounted) yoga classes at the workplace.

 

Today thousands of employers offer yoga classes on the worksite for their employees for a reduced or no cost to individuals. Classes are generally offered during lunch hours (11 a.m.-2 p.m.) or after work (4-6 p.m.), which makes them convenient for individuals who have difficulty with the class times and location of the yoga class. The reduced cost of the classes eliminates the financial barrier and is generally provided by the employer as a part of an employee wellness program. The major barrier of finding time in one's schedule is addressed by providing employees paid time away from work to engage in wellness activities (1-2 hours each week), such as attending a yoga class, or many individuals will use their lunch hour one or two days a week to attend a yoga class. Furthermore, classes are often offered during the lunch hour or some classes are offered after work.

 

Worksite wellness yoga classes also introduce yoga to individuals who may have been interested in trying yoga, but had not been able to because of lack of opportunity, misperceptions, or other common barriers. Worksite wellness yoga classes also present the opportunity for many individuals who do not regularly exercise to engage in physical activity. Many worksite wellness yoga classes are taught with variations poses and levels of difficulty for each pose or posture, which allows individuals of many different abilities to participate in yoga classes.

 

Worksite wellness yoga classes offer many benefits to employers because of the limited amount of equipment that is necessary to offer this physical activity. Other activities require more equipment and space such as spin classes (cycling), weightlifting, cardiovascular equipment (treadmills, elliptical machines, etc.), and sports that require a gymnasium. To offer a yoga class, an employer simply needs a certified yoga instructor, a room with floor space for yoga mats, and yoga mats for each individual ($8 minimal cost per yoga mat). Any room can be used for a yoga class if desks and chairs can easily be moved against walls, or classes can even be held outside on a grassy area if the temperature and ground conditions allow for this. The only regular cost is the yoga instructor's fee, which ranges from $20-$50 per class. However, a flat fee could be arranged that would minimize cost and provide more financial security to the yoga instructor. In some instances an employee of the business may be a certified yoga instructor and offer to teach classes for no charge.

 

When employers offer wellness classes such as yoga in the workplace, this helps address many of the common barriers for individuals to engage in physical activities. Yoga classes can improve individuals’ flexibility, balance, strength, cardiovascular health, calmness, relaxation, and an overall benefit to well-being (many individuals report they always feel better after a yoga class). Additionally, yoga classes require little start up cost to begin and can be taught to a wide range of individuals from children to any adult including older adults and senior citizens. As employers continue to battle the rising cost of health care for their employees (largely related to preventable chronic diseases and conditions such as: heart disease, cancer, stroke, diabetes, obesity, and mental health issues), yoga classes have been shown to be a powerful and cost-effective part of the solution. Healthier employees mean more productive employees, and higher profits for businesses and increase quality of life for communities.


Brandon Eggleston, PhD, CHES, directs the health promotion/worksite wellness program at the University of Southern Indiana and is a certified yoga instructor. He has been teaching yoga for the past year to his colleagues at USI (at no cost to the employer or employees). This model for employee wellness is based off the model developed by the Mayo Clinic and Cleveland Clinic.

 

Brandon M Eggleston, PhD, CHES
Assistant Professor of Health Services
Biostatistician Consultant
Certified Yoga Instructor
College of Nursing and Health Professions HP 2110
University of Southern Indiana
8600 University Blvd
Evansville IN 47712
Phone: (812) 461-5497
Fax: (812) 461-5356
http://health.usi.edu/faculty/Eggleston%20%20Homepage.pdf

ACHP SPIG Policy Group

 

ACHP SPIG Policy Group

 

By Donna M. Feeley, MPH, RN

Since the signing of the Patient Protection and Affordable Care Act in March of this year, there is considerable opportunity for the development of a national integrative health care strategy. As part of this, President Obama signed an executive order, on June 10, for the establishment of the National Prevention Health Promotion and Public Health Council under the U.S. Department of Health and Human Services. The Council will be responsible for coordinating leadership in health promotion, public health, wellness and integrative health among federal departments and agencies as well as develop a national prevention, health promotion, public health and integrative health care strategy. The strategy will “incorporate the most effective and achievable means of improving the health status of Americans and reducing the incidence of preventable illness and disability in the United States .”


As noted in our Winter newsletter, there has been significant progress achieved over the last 30 years with the Health Objectives for the Nation. This new Act avails itself to parallel and expand upon the significant strides made in Health Promotion and Disease Prevention through these national objectives. It is now a unique and opportune time to enhance these efforts with the inclusion of CAM and Integrative Health. In capitalizing on past and existing efforts in health promotion and disease prevention – a pathway toward its expansion in an effective and achievable way is readily available. The APHA SPIG Policy Group is in the process of analyzing and forming a policy statement on the integration of CAM in the 2020 Objectives for the Nation to help elucidate this opportunity. This effort will build upon past and existing efforts in health promotion and the integration of relevant CAM practices in meeting those Objectives.


I will the attending the upcoming Stakeholders Conference on Integrated Health Care Reform (convened by the Integrated Healthcare Policy Consortium (www.ihpc.info), the Palmer Center for Chiropractic Health Policy (www.palmer.edu) and the Institute for Integrative Health (www.tiih.org) ) in Washington, D.C., Sept. 27-29. The overarching goal of this meeting is to bring stakeholders together to collectively build a collaborative approach for implementation of the Act. As part of that, participants will be developing an understanding of the key provisions and opportunities that support integration and prevention.


At this time, the policy group is seeking additional members. If you are interested, please contact Donna M. Feeley at dfeeley@jhsph.edu

Challenging the Assumptions of Beneficence of Health Care Integration in Low-Income Countries

 

Editorial


Challenging the Assumptions of Beneficence of Health Care Integration in Low-Income Countries


Paul Kadetz, LAc, APRN-BC, MSc, MSOM, MSN, MPH, PhD (cand.)

At the ninth Meeting of the Consortium for the Globalization of Chinese Medicine (CGCM) held in Hong Kong this past August, scientists, physicians, academics and a smattering of TCM practitioners presented three days of posters and discussions primarily on how best to validate and standardize Chinese medicine. The goal, purportedly, was toward a call for a “One world medicine”; oddly reminiscent of Mao Zedong's call for the complete unification of Chinese Medicine and biomedicine in order to form a new hybrid medical system over half a century before. However, Mao's motivation was political and practical, in attempting to both redress health disparities in rural China and to maintain the employment of the large population of Chinese medicine practitioners (Taylor 2005). The motivation for the standardization and validation at the CGCM conference was less clear and points to issues in the assumed beneficence of the integrative medicine discourse that has been the predominant output of the Traditional Medicine Unit of the World Health Organization since the Declaration of Alma Ata. In the Declaration of Alma Ata the use of heterodox practices and practitioners to redress health care disparities through the use of local resources is the main identified reason for the integration of heterodox health care into formal biomedical health care systems. However, over the past 35 years, this original goal for redressing health care disparity seems to have become lost in the discourse for safe, effective, appropriate and standardized heterodox systems.

 

The question then arises, for whom is this validation and standardization? Is this process necessary to redress health care disparities, especially in low-income countries? In research the author conducted in four municipalities of the Republic of the Philippines over the past two years, less than 5 percent of 1,000 informants even understood the Western concepts of safety and efficacy, much less were concerned with the safety and efficacy of their local heterodox health care practices and practitioners. The predominant sentiment was that if a given practitioner did not help them, they would not return to that practitioner. Furthermore, the major assumptions of the discourse of health care integration were challenged in these contexts.


1) Health care integration increases access to health care.

In comparing communities that integrated (primarily imported heterodox practices) into their local health care system with communities that did not engage in integration, there has been no improvement in either physical access (operationalized as the distance to one's primary practitioner) or in terms of financial access to health care. In fact, in some instances integration decreased financial access to health care, as some local heterodox practitioners that normally accepted donations employed set fees after receiving standardized training from the Department of Health.

 

2) Health care integration facilitates collaboration between biomedical and heterodox practitioners to redress health care disparity.

Although, the referral of patients from heterodox practitioners to biomedical practitioners remained consistently high in all communities investigated, regardless of the presence of integration, referral from biomedical practitioners to local heterodox practitioners was identified to have decreased in many communities that integrated. In general, referral was more highly correlated with the financial capabilities of the patient than with integration.


3) Health care integration improves safety and efficacy of appropriate health care, thereby improving population health.

From a Western perspective, it appears quite obvious that by improving the “quality” of health care, population health will also improve, but this has not been demonstrated in the communities investigated. In fact, integration of “safe and effective” heterodox health care is posing a threat to community health in the Philippines. This is most clearly illustrated in the 2008 Administrative Order from the Department of Health of the Philippines that designates all pregnant women “at-risk” and demands that all women deliver in-facility with skilled birthing attendants and that all Traditional Birth Attendants (or Hilots) be prohibited from delivery in order to be “integrated” into the maternal-child health care team. In a country where 80 percent of rural women prefer to deliver at home with Traditional Birth Attendants (who generally only accept donations) and where the majority of birthing facilities are inaccessible or do not have the capacity and resources for such a change (due to the well-documented “brain drain” of medical professionals from the Philippines), this policy can prove particularly threatening to poor, rural women.


4) Health care integration increases the use of local heterodox health care practices.

Again, from an ethnocentric Western perspective it appears obvious that health care integration will increase the quantity of human resources in health care, however, it is quite ignorant to assume that all heterodox health care practices are equivalent. Therefore, it is important to question what is being integrated. Are local heterodox practices being integrated, or are they being replaced by imported heterodox systems such as acupuncture, as is currently occurring in the Philippines? In the communities assessed, the use of local heterodox health care was more a function of financial ability than integration. In fact, several local heterodox practitioner informants complained of a reduction in patients and a feeling of being marginalized in communities that have integrated.

 

This then brings us to question, what may be lost in this process of integration? What happens to local unstandardized heterodox systems in a paradigm of health care integration that demands standardization in order to achieve safety and efficacy? What happens when local heterodox health care that serves a specific socio-cultural function is replaced with imported heterodox health systems such as TCM? What happens when newly integrated health care systems can no longer serve socio-cultural functions and culture-bound illnesses are reduced to a DSM-IV diagnosis with a psychotropic treatment? What is lost when, as presenters at the Consortium for the Globalization of Chinese Medicine discussed, you try to “simplify” a heterodox practice for scientific understanding and dissemination?

 

Hence, there may possibly be a way to “do” integration that is appropriate for each local context and best decided by the local context, rather than something decided by a group of “experts” in Hong Kong and Geneva. Global health policy and global governance seem to disregard the local level in monolithic conceptions of beneficence. This research, then, suggests that what may be gained by adhering to a beneficent concept of health care integration must be considered in terms of what may be lost in local level health care and how this may ultimately alter the social fabric of communities and the delicate mechanisms that function to maintain the health of vulnerable populations.

 

References

Taylor, K. 2005. Medicine of Revolution. Chinese Medicine in Early

Communist China. London: Routledge.

 

 

Paul Kadetz

Department of International Development

Queen Elizabeth House

University of Oxford

paul.kadetz@qeh.ox.ac.uk

 

Announcements

 

Announcements

 

Congratulations to new ACHP PhD’s!

Steffany Haaz was awarded her doctorate at Johns Hopkins School of Public Health. Her dissertation was entitled “Examining the safety, feasibility and efficacy of yoga for persons with arthritis”.

Boston University School of Public Health awarded Beth Sommers with a doctorate for her dissertation “Role of Acupuncture as an Adjuvant Therapy in the Treatment of HIV/AIDS: Examining Disparities in Access, Cost-effectiveness of Using Acupuncture as a Promoter of Adherence to Antiretroviral Treatment, and Public Health Considerations”.


 

Tomorrow’s Leaders in Complementary and Integrative Care: Students

We want your news here! Use our newsletter to find mentorships, connect with others in your field, or to discover topics for your thesis or dissertation.

Students welcome!

 
 

Send us your publications!

We’d like to introduce a new section to our newsletter that includes recent publications by our members. When you publish your articles, please send the citation to our newsletter, and we’ll be happy to include it.

The bibliography that will be created can serve as a touch-point for other researchers and students. Please consider sending information about your publications to newsletter co-editors, Paul Kadetz (sharpdrpaul@yahoo.com) or Beth Sommers  (elizabeth.sommers@verizon.net). We’ll help you promote your work!

 


 

Don't forget to help recruit new members to ACHP.

Let's make this the year our SPIG becomes a Section!

See you in Denver.