Volume 148, Issue 3, 30 July 2013, Pages 746–754
Review
Intercultural health and ethnobotany: How to improve healthcare for underserved and minority communities? ☆
Abstract
Ethnopharmacological relevance
The
present conceptual review explores intercultural healthcare—defined as
the integration of traditional medicine and biomedicine as complementary
healthcare systems—in minority and underserved communities. This
integration can take place at different levels: individuals (patients,
healers, biomedical healthcare providers), institutions (health centers,
hospitals) or society (government policy).
Background
Contemporary
ethnobotany research of traditional medicine has primarily dealt with
the botanical identification of plants commonly used by local
communities, and the identification of health conditions treated with
these plants, whereas ethnopharmacology has focused on the bioactivity
of traditional remedies. On the other hand, medical anthropology seems
to be the scholarship more involved with research into patients'
healthcare-seeking itineraries and their interaction with traditional
versus biomedical healthcare systems. The direct impact of these studies
on public health of local communities can be contested.
Aim of the review
To
compare and discuss the body of scholarly work that deals with
different aspects of traditional medicine in underserved and minority
communities, and to reflect on how gaps identified in research can be
bridged to help improve healthcare in these communities.
Key findings
The
literature covers a broad range of information of relevance to
intercultural healthcare. This information is fragmented across
different scientific and clinical disciplines. A conceptual review of
these studies identifies a clear need to devote more attention to ways
in which research on traditional medicine can be more effectively
applied to improve local public health in biomedical resource-poor
settings, or in geographic areas that have disparities in access to
healthcare.
Conclusions
Scholars
studying traditional medicine should prioritize a more
interdisciplinary and applied perspective to their work in order to
forge a more direct social impact on public health in local communities
most in need of healthcare.
Graphical abstract
Keywords
- Public health;
- Traditional medicine;
- Cultural competence in healthcare;
- Medicinal plants;
- Ethnosciences;
- Conceptual review
1. Introduction
The
present conceptual review paper explores intercultural healthcare in
minority and underserved communities (collectively called here “local
communities”) that have a long history of using herbal remedies in
traditional medicine. Traditional herbal medicines can be
defined as “naturally occurring, plant-derived substances with minimal
or no industrial processing that have been used to treat illness within
local or regional healing practices" ( Tilburt and Kaptchuk, 2008). Intercultural healthcare
consists of “practices in healthcare that bridge indigenous medicine
and western medicine, where both are considered as complementary” ( Mignone et al., 2007). Within this context, indigenous or traditional medicine
stands for “the knowledge, skills and practices based on the theories,
beliefs and experiences indigenous to different cultures, whether
explicable or not, used in the maintenance of health, as well as in the
prevention, diagnosis, improvement or treatment of physical and mental
illnesses“ ( World Health Organization, 2000).
This includes, among others, consultation with traditional and
spiritual healers, herbalists, birth attendants, bone setters, diviners
and others, as well as the use of plants, animals and minerals for
self-medication. For the purpose of the present manuscript, the term indigenous is expanded to include all local communities worldwide that use traditional medicine as part of their cultural heritage.
According to the World Health Organization, health
is “a state of complete physical, mental and social well-being” and not
merely “absence of disease or infirmity”. This definition corresponds
well with the inclusive nature of traditional medicine that extends
beyond the physical body into a broader social, cultural and spiritual
context of health and well-being. The importance of traditional medicine
in global healthcare is reflected by the three A's: Affordability,
Availability and Accessibility. This is especially true in rural areas
lacking in biomedical healthcare, but also in immigrant communities in
large urban centers, regardless of the increased availability of
biomedicine in the latter places ( Pieroni and Vandebroek, 2007).
Even
though the World Health Organization has continued to endorse
traditional medicine since the seventies, implementation of
intercultural healthcare in practice has proven a difficult task for
most countries to date. This may be due, in part, to the strained
institutional relationships between both healthcare systems. With the
exception of some countries, for example China, the Republic of Korea
and Vietnam, the position of traditional medicine in relation to the
predominance of the biomedical healthcare system remains much debated (Payyappallimana, 2010).
At the societal level, several barriers to intercultural healthcare are
known to exist, such as its general acceptance by biomedical healthcare
providers, and issues related to the safety, efficacy, quality and
rational use of traditional medicine. Furthermore, debate has been
ongoing whether both medical systems should be integrated, or rather
allowed to co-exist. Others argue that traditional medicine needs to be
evaluated within its own framework rather than approved and subdued by
the rules of biomedicine (Gorn and Sugiyama, 2004).
The difficult institutional relationship between traditional medicine
and biomedicine stands in sharp contrast to its reality in the daily
lives of many people, who often spontaneously use both systems together,
either subsequently or jointly, and consider them as complementary
systems instead of being mutually exclusive (Gorn and Sugiyama, 2004 and Payyappallimana, 2010).
Ethnobotanical
research has a long history of investigating plants and health
conditions that are important in traditional medicine. For many years,
one of the main interests of research into medicinal plants has been to
identify new plant leads for drug discovery programs (Cox and Balick, 1994 and Fabricant and Farnsworth, 2001).
In spite of the importance of these programs to improve general public
health, their short and long term impact on public health in local
communities is less clear and has often been overlooked, especially in
societies that do not have the purchasing power for marketed
pharmaceuticals (Nyigo and Malebo, 2005).
The main objective of this conceptual review is to compare and discuss
the body of scholarly work that deals with different aspects of
traditional medicine in local communities, and to reflect on how gaps
identified in research can be bridged to help improve healthcare in
these communities.
It is
important to emphasize that this is not a systematic review aimed at
generating an exhaustive summary of literature studies that deal with
traditional medicine and intercultural health. As a consequence, some
studies are not cited. The ones that are cited illustrate the main
arguments put forward in this paper and will inevitable include a
certain degree of author bias. Rather, this review is conceptual and was
guided by my understanding of the scholarship that studies traditional
medicine, as well as by a literature search on the key-words
“traditional medicine” in combination with “public health”, “primary
healthcare”, “biomedicine” or “intercultural health” in Ovid Medline
from 1980 to 2013. Studies selected from this literature search were
compiled in a Microsoft Excel table and summarized by their main focus
of inquiry. From this exercise, five main types of studies were
identified that are discussed in the following paragraphs. In addition,
two initiatives in which I have been involved are also described; these
initiatives attempt to bridge academic and applied research through
interactions with communities that use traditional medicine and
biomedical healthcare providers.
The
main argument put forward in this manuscript is that scholars studying
traditional medicine should prioritize a more interdisciplinary and
applied perspective to their work in order to forge a more direct social
impact on public health in local communities. The importance of this
social dimension of traditional medicine became a priority to me through
observations from fieldwork that in some communities medicinal plants
continue to be the main (or in more pronounced cases the only)
available, accessible or affordable option for healthcare (e.g., Vandebroek et al., 2004a).
These observations were reinforced by the perceived lack of coverage in
the ethnosciences literature of research activities that can directly
contribute to mitigating this health disparity.
