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Integrator Resource: Complementary and Alternative Medicine in the 2011 National Prevention Strategy PDF Print E-mail
Written by John Weeks   
Tuesday, 19 July 2011

Integrator Resource: Inclusion of Integrative Health and Complementary and Alternative Medicine in the June 2011 National Prevention Strategy

Summary: The National Prevention, Health Promotion and Integrative Health Council established under the Obama-Pelosi Affordable Care Act mandated development of a whole system approach to prevention and health promotion. The law highlighted the new concept of "integrative health." Lawmakers mandated the inclusion of integrative practitioners in the Council's Advisory Group. In June 2011, the Council published the National Prevention Strategy: America's Plan for Better Health and Wellness. "Integrative health" merited a single, undefined mention. Complementary and alternative medicine was mentioned 4 times. Massage, spinal manipulation and acupuncture each were mentioned once. Zero reference was made toward any other related modalities, disciplines or systems. This Integrator Resource includes all direct references to "integrative health" and related modalities and disciplines with the location of each in the document.
Note: This resource was first published in similar form in the July 2011 Integrator Round-up.
Because of the article's potential value as a resource, I am separately publishing it here.

Send your comments to
for inclusion in a future Integrator.

Image
Published June 2011
The
National Council on Prevention, Health Promotion and Public Health Council published its National Prevention Strategy just prior to the June 30, 2011 deadline. The subtitle for the 125 page document is America's Plan for Better Health and Wellness.

The Council was established under Section 4001 of the 2010 Affordable Care Act (ACA). The
list of the first 4 "Purposes and Duties" of the Council references to "integrative health" 3 times. Following a mandated inclusion of integrative health professionals on the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health that was to help frame the strategy, acupuncturist Charlotte Kerr, RSM, BSN, MPH, MAc, and integrative physician Sharon Van Horn, MD, MPH were each appointed.

This Integrator Resource is the product of a series of simple search of terms in the document published in June 2011.

_____________________________________________

Integrative Health and Related Terms in the National Prevention Strategy


Image
National Prevention Strategy figure
1.  Summary of the numbers of inclusions for individual search terms


  • complementary and alternative medicine (4)
  • integrative health (1)
  • integrated health care (1)
  • massage (1)
  • spinal manipulation (1)
  • acupuncture (1)
  • integrative medicine (0)
  • naturopathic (0)
  • herbs (0)
  • botanicals (0)
  • vitamins (0)
  • chiropractic (0)
  • integrative practitioner (0)
  • mind-body (0).

Below are the references in their entirety, with the page numbers in
America's Plan for Better Health and Wellness.


2.  Reference to Integrative Health (page 8)


Under Assess New and Emerging Trends and Evidence:
"The prevention landscape continuously evolves as scientific evidence, new plans and reports, new legislation, and innovative partnerships emerge. The Strategy will adapt its approaches as new
information becomes available. The National Prevention Council will gather input to identify promising practices and innovative approaches to prevention and integrative health. The Council will maintain close ties to prevention practice and research, updating policy and program recommendations as new evidence becomes available. The Council will review new and emerging data and evidence, prioritizing our nation’s health needs and providing information to the President and Congress concerning the most pressing health issues confronting the United States."


Image
Charlotte Kerr: Advisory Group member
3.  Complementary and Alternative Medicine (page 14)


The first mention of complementary and alternative medicine is under the Recommendations related to the plan's Strategic Priorities:
"Future research and evaluation, including well designed trials for many complementary and alternative medicine therapies, will be critical to addressing unmet prevention and wellness needs, and new evidence-based strategies will be incorporated as they emerge." (page 14)

4.  Complementary and Alternative Medicine, Integrated Health Care, Massage, Acupuncture, and Spinal Manipulation (page 22)

The most significant inclusion is under "Recommendations: What Can be Done?" on page 22 under Clinical and Community Preventive Services. This section also includes the references to acupuncture, massage and spinal manipulation.
"Recommendation #6: Enhance coordination and integration of clinical, behavioral, and complementary health strategies.
"Integrated health care describes a coordinated system in which health care professionals are educated about each other's work and collaborate with one another and with their patients to achieve optimal patient wellbeing. Implementing effective care coordination models (e.g., medical homes, community health teams, integrated workplace health protection and health promotion programs) can result in delivery of better quality care and lower costs. Gaps and duplication in patient care, especially among those with multiple chronic conditions, can be reduced or eliminated through technologies (e.g., electronic health records, e-prescribing, telemedicine). Evidence-based complementary and alternative medicine focuses on individualizing treatments, treating the whole person, promoting self-care and self-healing, and recognizing the spiritual nature of each individual, according to individual preferences. Complementary and alternative therapies for back and neck pain (e.g., acupuncture, massage, and spinal manipulation) can reduce pain and disability." (page 22)

Image
Sharon Van Horn: Advisory Group member
5.  Research on Complementary and Alternative Medicine (page 22)


Under Recommendation #6, under Action Steps for the Federal Government:
"Research complementary and alternative medicine strategies to determine effectiveness and how they can be better integrated into clinical preventive care." (page 22)

6.  Care Delivery and Complementary and Alternative Medicine (page 23)


Under Recommendation #6, under for action steps for Health Care Systems, Insurers and Clinicians:
"Facilitate coordination among diverse care providers (e.g., clinical care, behavioral health, community health workers, complementary and alternative medicine)."
___________________________

Image
Source of
Comment: 
The first take-home for the integrative practitioner community is that the concept of "integrative health" as a new direction is essentially a non-starter in this document.
While advocated by most "integrative health" practitioners as a whole person, primary-prevention, lifestyle changing approach to care, "integrative health" gains no such status in this document. The explicit concept of "integrative health," so visible in the Council's charge, was virtually lost on the way to the strategic plan. This represents a huge, missed opportunity.

One can see, however, two, positive, related developments. One is the description of
"CAM" in Recommendation #6.  These fields are presented as part of the paradigm most integrative providers posit:
" ... individualizing treatments, treating the whole person, promoting self-care and self-healing, and recognizing the spiritual nature of each individual, according to individual preferences."
However, no direct link is made between this description of "CAM" and the definition of "integrative health." The latter is not defined.

   
The National Prevention Strategy's
definition of "integrated health care"
is a word-for-word reflection of a
definition provided to the Surgeon
General in a march 2011 letter from
the Integrated healthcare Policy
Consortium.


    
A term that is defined, in the beginning of Recommendation #6, is "integrated health care." The notice of the National Prevention Plan's definition of this term in the July 2011 Integrator Round-up stimulated a note from Janet Kahn, PhD. Kahn recognized a word-for-word recapitulation of language the Integrated Healthcare Policy Consortium offered in a March 24, 2011 letter to US Surgeon General Regina Benjamin, MD, MBA, on National Prevention Strategy effort. IHPC's letter, which listed IHPC's 5 priorities for the Council, included this introductory segment:
" ... IHPC is a broad coalition of clinicians, patients, healthcare educators and organizations committed to public policy that ensures all Americans access to safe, high quality healthcare, including the full range of qualified conventional, complementary and alternative healthcare professionals.  Integrated health care describes a coordinated system in which healthcare professionals are educated about one another's work and collaborate with one another, and with their patients, to achieve optimal well-being for the patient. Integrated healthcare, of course, provides for the population's full health needs from primary prevention through acute illness and trauma care to palliation and compassionate end of life care.  Its hallmarks, however, are a focus on health promotion and patient engagement through strong relational care."
Kudos to Kahn and IHPC for this effort to clarify, for policy makers, and the public what these new concepts and approaches might mean.

Image
Surgeon General Benjamin
The members of the Council's Advisory Group are listed on page 64 of the National Prevention Strategy. Two of these, Kerr and Van Horn, likely assisted in ensuring the inclusions of the language noted here.

The work of the Advisory Group and of the Council is not done. In fact, as noted in the June 2011 Integrator Round-up, the Advisory Group has established a Working Group on Prevention. The charge of this subset is to
"gather background information and evidence that can be used to effectively describe a continuum of services that includes clinical, community, and integrative approaches to prevention." (Bold added.)

Opportunities remain to influence the US strategy. Here are the coordinates for connecting with the plan authors:
For more information about the National Prevention Strategy, go to:
http://www.healthcare.gov/center/councils/nphpphc


Office of the Surgeon General

5600 Fishers Lane
Room 18-66
Rockville, MD 20857

email:


Send your comments to
for inclusion in a future Integrator.


Last Updated ( Wednesday, 20 July 2011 )
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