CAM represents an important part of healthcare delivery and provision in Europe. It is a rapidly growing part of the economy, used by significant numbers of EU citizens. CAM should be included in EU strategic approaches to health promotion and prevention but it is currently largely ignored by those who make EU health policy. CAM can significantly contribute to answer the needs of such European priorities as improving public health, enabling healthy ageing, providing affordable health systems, reducing antimicrobial resistance and redressing health inequalities.
Personal responsibility for one's own health is a vital aspect in the prevention of illness. CAM has always been a strong proponent of:
- a more prominent role for the patient in the health care system
- the right of patients to assume responsibility for their own healthcare
- encouraging and enabling citizens to become more knowledgeable about health related subjects.
Health competence is a term now used to describe the knowledge, skills and development of the right attitudes to live a healthy life. Health competence includes knowledge of and engagement in healthy eating, exercise, maintaining a healthy environment, healthy relaxation and a healthy work-life balance. The furtherance of health competence is a key feature of CAM: CAM practitioners are able to make significant contributions in the field of “health competence” and their expertise should be utilised by those making health policy.
According to a Commission document, “Pharmaceutical development has led to thousands of medicines available worldwide, but many medicines are not as effective as expected in all patients, and some patients may suffer from serious adverse reactions. The reason for this is that therapies traditionally have been developed, and prescribed, using an ‘average patient’ approach that does not take into account patients’ ‘molecular make-up’, a factor that, together with environmental and lifestyle factors, determines susceptibility to disease, the course of disease, and response to treatment.”
Personalised medicine is a medical approach which is tailored to the patient or a group of patients – whether for prevention, prognosis or treatment. In other words, it moves away from the common "one size fits all" medical model. This approach is now financially supported by the European Commission.
CAM is, in fact, personalised medicine ‘avant la lettre’. Knowing the patient's constitutional nature and temperament enables the CAM health professional to adjust and individualise the treatment strategy accordingly for optimum efficacy.
CAM is generally considered safe and this is a major reason for its popularity. Individual risk levels may however vary from one CAM therapy to another but adverse effects noted in research literature are rarely of a serious nature. Unregulated herbal medicines may present a risk of adverse effects and whilst there is a possibility for interaction with conventional medicines, in the hands of properly trained herbalists such risks are minimal. Herbal medicinal products can be acceptably safe if used properly and under the guidance of an appropriately trained professional.
EU statistics reveal that 8-12% of patients admitted to hospital suffer adverse events from conventional medicine while receiving care and at least 198,000 patients die each year from medical errors whether from adverse drug reactions, antibiotic resistant micro-organisms, wrong diagnosis or surgical error. The costs of dealing with the consequences of these events run into billions of euros annually. The good safety profile of CAM is another cogent reason for CAM to be integrated into health systems, thereby reducing some of the more high-risk interventions which inevitably pose more risks to patient safety.
Professional CAM associations consider user safety as paramount and have therefore established guidelines for training, certification and practice, as well as requiring professional insurance and operating robust codes of ethics and complaints procedures.
Over the last few decades an increasing amount of research has been published on the effectiveness of CAM modalities, notably acupuncture, anthroposophic medicine, herbal medicine, homeopathy, massage, naturopathy, reflexology, shiatsu, traditional Chinese medicine and others in peer-reviewed scientific journals. Research ranges from basic science studies related to identifying potential mechanisms of action, to randomised controlled clinical trials in humans and animals, to observational cohort studies, to comparative effectiveness studies, to cost-effectiveness studies and health services research. Read more at Research.
Supporting good health and prevention of illness is now recognised as having the greatest cost-effective and health outcome potential both for citizens and health systems. Good health is a value in itself and promoting the well-being of its peoples is enshrined in article 3 the Treaty of Lisbon. Good health is now also recognised as an economic driver as well as a cohesive force in families and communities. The strategic aim of the EU Commission “Health for Growth” seeks substantially healthy longevity.
CAM modalities are typically not dependent on complex and expensive technological interventions, instead providing low-cost treatments. In contrast with conventional prescription drugs, homeopathic, herbal and anthroposophic medicines are generic, non-patentable medicinal substances that are produced at relatively low costs. By and large they do not incur any further costs caused by adverse effects.
CAM modalities can often be used as a first option in treating many conditions, sparing the use of more costly biomedical drugs which nevertheless remain as a possible backup. CAM modalities can help to prevent the often long-term dependency on conventional medication and to reduce the enormous burden of mortality and morbidity caused by the adverse effects of conventional biomedical drugs and the ever-increasing resistance to antibiotics.
The use of CAM modalities may therefore offer significant cost savings to public health systems and to the economy more widely. Several research studies have demonstrated that patients who were treated with various CAM modalities used fewer medications, had better health, fewer days off sick, and fewer visits to medical specialists than patients of conventional physicians all of which can contribute to long-term compound savings in health budgets.
Both the WHO and the EU have identified antimicrobial resistance 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 antimicrobial resistance (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 health and animal health.
By 2025 about one-third of Europe’s population will be 60 years or over and there will be a significant increase in the number of people 80 years and older. European societies need to support healthy people living longer and productive lives. Without a sea change that sees positive measures implemented to support the aims of Healthy Ageing, the burden on care services may become intolerable.
CAM’s focus is on salutogenesis is inherently geared to supporting healthy active longevity. Surveys show that it is in early middle age that citizens begin to regularly use CAM when awareness about the need to stay healthy and the onset of chronic illness tend to coincide, and when they are seeking methods to take care of their health in a positive and sustainable way.
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. This is an area where CAM professionals can provide added value by supporting their patients to adopt healthy behaviour, a key challenge in tackling lifestyle-related chronic conditions. 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.
Analysis of the relation between health and socio-economic status consistently reveals that better health is enjoyed by those with higher economic status. Similarly, use of CAM is associated with those with higher economic status. Due to the fact, that CAM modalities are not integrated in the public health system, patients have to rely on private funds or private health insurance companies to pay for CAM medicinal products. While a direct relation between these two sets of data remains to be firmly established, the fact that access to the benefits of CAM are currently only available to those who can afford to pay for them and know about them, clearly points to inequality of access to CAM by poorer EU citizens. The different regulatory framework for CAM across the EU further adds to such inequalities, as patients in some Member States have access to more treatment choices than do the populations of other Member States.
CAM can contribute in several ways to reducing health inequalities. Several CAM modalities combine basic health education with treatment of illness. They can be delivered both on an individual basis, in community settings and within formal education. Delivery is personalised with a high motivation capacity leading to the desire for and uptake of personal responsibility for health and to a level of health literacy that can aid the prevention of illness. In addition, the use of cost effective CAM interventions in the treatment of illness frees available resources for other programmes to reduce health inequalities.
While the organisational structure and funding mechanisms of health systems varies across Europe, the general reliance on the biomedical model of healthcare with all its associated costs, inefficiencies, inequalities of access and patient dissatisfaction calls for a radically new approach. With increasing costs of the treating of chronic disease, the inexorable increase in costs associated with an ageing population and the demands of ever more expensive medical technologies, there appears little prospect that resources can match demand. Systemic change is required.
CAM offers solutions to these seemingly intractable problems providing healthcare delivery based on supported self-responsibility and health literacy that can do much to support health maintenance and the prevention of illness. 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 small but growing amount of evidence to show that the introduction of CAM into primary care can improve morbidity and mortality while reducing healthcare costs.
The CAMbrella project calculated there are some 300,000 CAM providers working in the EU. Most of them are currently practitioners or MDs 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.
In the last decade a set of policy orientations for European public health policies has been developed by the EU Commission like ‘health in all policies’ or the guideline ‘Health for Growth’. These strategies aim to integrate European health policies within all other European policies. Due to the financial and economic crisis, the overarching aim of the EU Commission is now to concentrate all political activities of the Union on achieving a better economic performance.
Because it accounts for major outlay of public finances, health policy is a focus of this development. The EU Commission health department, DG SANCO, has therefore suggested concentrating European public health policies on ‘Investing in Health’ with the objective to invest in sustainable health systems, to focus on health as investment in human capital and to reduce inequalities in health. These general policy objectives suggest substantial changes to the existing health system, improving its cost efficiency through sound innovation, promoting good health and investing in human capital. Finding cost-reductions whilst ensuring the provision of better health for the European workforce are paramount.
CAM is consistent with the priorities of this EU Health Strategy particularly promoting healthy ageing 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 that are major causes of lost work days like back pain, stress and depression. 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.