Public Health/AAHE

A Multicultural Perspective

Helda Pinzon-Perez, Miguel A. Pérez, Helda Pinzón-Pérez, Miguel A. Pérez, Helda Pinzon-Perez, Miguel A. P¿rez

• Publisher: Jossey-Bass
• Year: 2016
• ISBN:
  9781118880425
• Edition: 1
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

Complementary, Alternative, and Integrative Health: A Multicultural Perspective provides a critical analysis of non-allopathic healing practices, including their uses, limitations, and scientific basis. The evidence-based discussion explores complementary, alternative, and integrative health (CAIH) across various cultural and ethnic groups both in the U.S. and internationally, to give you a greater understanding of the different modalities—including a literature-backed examination of proven methods and questionable practices within a cross-cultural framework. Each chapter highlights the scientific analysis of the practices relevant to each group, and guides you toward independent analysis of the risks and benefits of the practices discussed. Emphasizing the student as a future health professional, this book includes case studies, examples, questions, and discussion problems that underscore the role of health educators in educating consumers about CAIH practices.

CHAPTER 1
EXPLORING COMPLEMENTARY, ALTERNATIVE, AND INTEGRATIVE HEALTH
Overview, Limits, and Controversies

Cyndi Guerra, Cheryl Hickey, and Helda Pinzón-Pérez

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LEARNING OBJECTIVES

At the completion of this chapter, students will be able to:

• Understand the importance of complementary, alternative, and integrative health (CAIH) and complementary and alternative medicine (CAM) in today's society.
• Differentiate current controversies between traditional medicine and complementary, alternative, and integrative therapies.
• Discuss strategies to bridge the gap between allopathic medicine and CAIH modalities.
• Provide an overview of CAM under the guidelines of the Affordable Care Act.

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Today's health economics often drives the cost of modern medications, treatments, and therapies. Increasingly, these dynamics polarize the patient-consumer roles and alienate patients in the same system from which they seek care. Patients diagnosed with chronic disease, or illnesses, are particularly vulnerable to the economics of healthcare. For example, issues such as polypharmacy significantly escalate the cost of care for patients. As a result, patients are driven to seek other alternatives. Consequently, healthcare practitioners and health educators, whose patients have begun to explore more self-regulated and less expensive options afforded through complementary, alternative, and integrative health (CAIH) approaches, increasingly find themselves in need of knowledge related to these models of care. In today's society, these modalities can represent a more accessible treatment option and a lower financial burden for already economically challenged and chronically ill consumers.

Despite a young and limited body of formal research, as well as mixed conclusions regarding treatment efficacy, several motivations have fueled the patient/consumer's desire to use complementary and alternative treatments for addressing physical problems and for maintaining good health. This chapter explores the reasons patients/consumers are driven to engage in CAIH practices and the factors that have led to the continued historical prevalence of complementary and alternative medicine (CAM) use. It also provides a contemporary overview of CAIH, a discussion of modern controversies surrounding CAM, and the need for healthcare providers to increase their education related to CAIH modalities.

Throughout this chapter and the others in this book, the names National Center for Complementary and Alternative Medicine (NCCAM) and National Center for Complementary and Integrative Health (NCCIH) are both utilized due to the 2014 name change of the major federal organization related to CAIH and CAM in the United States. In addition, the term Complementary, Alternative, and Integrative Health will be used under the acronym CAIH to reflect an emphasis on health and wellness.

In this book, the acronym CAM is replaced by CAIH to adhere to the current emphasis on complementary and integrative health. Although NCCIH refers to these practices as complementary and integrative health (CIH) approaches, the editors of this book added the word Alternative in the acronym to acknowledge that consumers are still using some of these practices as alternative forms of care.

While we recognize the value that the denomination CAM (Complementary and Alternative Medicine) has brought historically to our understanding of traditional health and alternative models of care, the acronym CAM is currently being abandoned and will only be utilized in this book when used by the bibliographical references consulted for this publication. For additional clarification on the terms used in this book, please read the preface.

Theoretical Concepts

The National Center for Complementary and Alternative Medicine (NCCAM), known since December 2014 as the National Center for Complementary and Integrative Health (NCCIH), is the leading federal agency on CAIH approaches in the United States. It is one of the 27 institutes and centers of the National Institutes of Health within the US Department of Health and Human Services. Its mission is to “define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health interventions and their roles in improving health and health care” (NCCIH, 2015a). Throughout this book, both names (NCCAM and NCCIH) will appear according to the term used by the bibliographical references.

The NCCIH (2015a) defined integrative health as the incorporation of complementary approaches into mainstream healthcare, bringing conventional and complementary modalities together in a coordinated way. CAM is defined as the integration of biomedicine, complementary, and alternative modalities used together with safety and efficacy (NCCAM, 2009). According to NCCIH (2015a), “complementary” medicine is when a nonmainstream practice is used together with conventional medicine; “alternative” medicine is when a nonmainstream practice is used in place of conventional medicine.

Complementary, alternative, and integrative health is a term that includes complementary, alternative, and integrative approaches to prevent and manage disease as well as to maintain or restore health and wellness. This term is congruent with the 2014 name change of the National Center for Complementary and Alternative Medicine to the National Center for Complementary and Integrative Health. The NCCIH (2015a) defines complementary health approaches as practices and products of nonmainstream origin.

The classification of CAM therapies by the NCCAM and the NCCIH has varied throughout the years. Initially, NCCAM divided CAM modalities into five categories:

1. Alternative medical systems
2. Mind-body interventions
3. Biologically based treatments
4. Manipulative and body-based methods
5. Energy therapies

Later, NCCAM (2014) grouped CAM practices into four categories:

1. Natural products
2. Mind and body medicine
3. Manipulative and body-based practices
4. Other CAM practices

This classification was revised again. The NCCIH (2015a) divided complementary health approaches into three subgroups:

1. Natural products
2. Mind and body practices
3. Other complementary health approaches

Natural products include products such as herbs, botanicals, vitamins, minerals, probiotics, and dietary supplements. Mind and body practices include procedures and techniques such as yoga, chiropractic and osteopathic manipulation, meditation, massage therapy, acupuncture, tai chi, qi gong, healing touch, hypnotherapy, movement therapies (Feldenkrais method, Alexander technique, Pilates, Rolfing Structural Integration, and Trager psychophysical integration), and relaxation techniques (breathing exercises, guided imagery, and progressive muscle relaxation). Other complementary health approaches include traditional healers, ayurvedic medicine, traditional Chinese medicine, naturopathy, and homeopathy (NCCIH, 2015a).

Complementary, Alternative, and Integrative Approaches and CAM in Contemporary US Society and around the World

It is important for healthcare practitioners to have knowledge regarding the wide range of treatment modalities associated with CAIH. Understanding the role of CAIH in health management can be a powerful tool for practitioners and consumers. CAIH therapies can be instrumental in disease prevention and treatment. For this reason, many consumers are showing increasing preference for such practices that used to be called CAM (NCCAM, 2008).

Understanding or assisting patients in integrating CAIH modalities into their healthcare does not necessarily indicate acceptance on the part of the health educator or healthcare practitioner. Rather, it indicates a willingness to allow patients to have more autonomy and control over their care.

There has been an expansion of wellness programs in the United States over the last few decades, and many of these programs utilize CAIH modalities. Increasingly, such modalities have appealed to the US population because of some promising findings for improved health and wellness (Gebhardt & Crump, 1990). The concept of health awareness enabled people to be more proactive and responsible for their own health. Wellness programs, which surfaced decades ago, offered incentives to employees who chose to live healthier lifestyles and included initiatives such as weight loss and smoking cessation programs (Erfurt, Foote, & Heirich, 1992).

Other venues beyond the work setting also began in the 1990s to promote health and wellness programs for populations. Research reinforced the value of wellness programs by showing that they could improve health and, in some cases, reverse chronic conditions. Many occupational settings, such as community and state health departments, hospitals, universities, and schools, began to promote healthy lifestyle programs to gain long-term health benefits (Institute of Medicine of the National Academies [IOM], 2005; National Institute for Health Care Management Research and Educational Foundation, 2011).

As a result of strong public interest in natural treatment modalities, two governmental entities emerged: NCCAM in 1999, formerly known as the Office of Alternative Medicine [OAM], and the White House's Commission on Complementary and Alternative Medicine Policy in 2000. This commission was formed to aid in the creation of public policy regarding CAM and served as a beneficial force in assisting the public's safe and efficacious use of CAM (Health and Human Services, n.d.).

President Clinton appointed several physicians, nurses, PhDs, and CAM providers to serve on the White House's Commission on Complementary and Alternative Medicine Policy. Both the NCCAM and the White House's Commission were intended to make recommendations and advise on public policy regarding the safety and efficacious promotion of products labeled as CAM. The NCCAM proved, over time, to be the most important initiative that gave scientific credibility to CAM therapies. Currently, the NCCIH (2015a) promotes the development of scientific evidence that will “inform decision making by the public, by health care professionals, and by health policymakers regarding the use and integration of complementary and integrative health approaches.”

Ultimately, the White House Commission introduced several guidelines in regard to CAM, including documented findings from research to support CAM use, product efficacy and safety for CAM-associated treatments, access to proper trainin...

Table of contents

• Cover
• Title Page
• Copyright
• Table of Contents
• Dedication
• Preface
• Acknowledgments
• About the Editors
• About the Contributors
• Chapter 1: Exploring Complementary, Alternative, and Integrative Health: Overview, Limits, and Controversies
• Chapter 2: Mind-Body Medicine
• Chapter 3: Natural Complementary and Alternative Medicine Modalities
• Chapter 4: Manipulative and Body-Based Practices
• Chapter 5: Ayurveda and Other Complementary Health Approaches
• Chapter 6: The Role of Spirituality in Healing
• Chapter 7: Complementary, Alternative, and Integrative Health Approaches among American Indians and Alaska Natives
• Chapter 8: Complementary, Alternative, and Integrative Health Approaches among Hispanics/Latinos
• Chapter 9: Complementary, Alternative, and Integrative Health Approaches among African Americans
• Chapter 10: Complementary, Alternative, and Integrative Health Approaches among Asian Americans, Native Hawaiians, and Pacific Islanders
• Chapter 11: Complementary, Alternative, and Integrative Health Approaches among Caucasian/European Americans
• Chapter 12: Complementary, Alternative, and Integrative Health Approaches among West Asian American Communities
• Chapter 13: Complementary, Alternative, and Integrative Health: Beyond the Paradigm of CAM
• Index
• End User License Agreement