By Hatim Jaber MD MPH JBCM PhD 14- 8-2018 Faculty of Medicine Public Health (31505291) الصحة العامة Lecture 26 Traditional Medicine By Hatim Jaber MD MPH JBCM PhD 14- 8-2018

Migration and Travelers' health Traditional Medicine The global health impact of mental health and mental diseases. Drug abuse and Addictive substances Global overview of communicable diseases Global overview Non- Communicable Diseases(NCDs) The global health impact of Hepatitis, Tuberculosis and HIV/AIDS The global health impact of Cardiovascular Diseases , Diabetes and Obesity Health policy and management, Health priorities Health policies and management within a global health perspective Healthcare service delivery in developed and developing countries Healthcare systems and financing Quality of care and effectiveness in different health services systems Violence and Injuries Migration and Travelers' health Traditional Medicine

Presentation outline 09:15 to 09:25 09:25 to 09:35 09: 35 to 09:40 Time 09:15 to 09:25 09:25 to 09:35 09: 35 to 09:40 09:40 to 09:50 09:50 to 10:15

What is traditional medicine? WHO defines traditional medicine as including diverse health practices, approaches, knowledge and beliefs incorporating plant, animal, and/or mineral based medicines, spiritual therapies, manual techniques and exercises which can be used to maintain well-being, as well as to treat, diagnose or prevent illness.

Background WHO defines traditional medicine as the sum total of 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 illness (http://www.who.int/medicines/areas/ traditional/definitions/en/index.html) The terms “CAM and alternative" (and sometimes also "non-conventional" or "parallel") are used to refer to a broad set of health care practices that are not part of a country's own tradition, or not integrated into its dominant health care system.

Complementary medicine Traditional medicine Traditional medicine has a long history. It is the sum total of the knowledge, skill, 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 illness.  Complementary medicine The terms “complementary medicine” or “alternative medicine” refer to a broad set of health care practices that are not part of that country’s own tradition or conventional medicine and are not fully integrated into the dominant health-care system. They are used interchangeably with traditional medicine in some countries. Herbal medicines Herbal medicines include herbs, herbal materials, herbal preparations and finished herbal products, that contain as active ingredients parts of plants, or other plant materials, or combinations. 

Traditional and Complementary/ Alternative Medicine Categories of TM/CAM Main Popular System of TM/CAM Traditional Chinese Medicine Indian Ayurveda Medicine Arabic Unani Medicine Homeopathy Chiropractic

Traditional and Complementary/ Alternative Medicine Categories of TM/CAM Medication Medicinal plants Mineral materials Animal materials Non-medication Acupuncture Chiropractic Osteopathy Manual therapies Qigong, Taiji, Yoga Physical, mental and spiritual therapies

Populations using TM/CAM worldwide Populations in developing countries using traditional medicine for primary health care Ethiopia Benin India Rwanda Tanzania Uganda Populations in developed countries who have used complementary and alternative medicine at least once Canada Australia France USA Germany

Herbal medicines are rapidly increasing in economic importance Marketing of Herbal Products (Thousand million US$) Annual sales of OTC herbal medicines in USA Great Britain

Accessibility: African countries use traditional medicine to help meet primary health care needs Populations reliant on traditional medicine for primary health care

Why traditional medicine? Accessible and affordable in developing countries RATIO OF PRACTITIONERS TO POPULATION Traditional Medical practitioner doctor Swaziland 1:100 1:10,000 Ghana 1:200 1:20,000 Uganda 1:700 1:25,000 Mozambique 1:200 1:50,000

Why traditional medicine? An alternative approach to health care in developed countries concern about the adverse effects of "chemical drugs", questioning of the approaches and assumptions of allopathic medicine, and greater public access to health information.

General considerations Despite its existence and use over centuries, traditional medicine has not been officially recognized in most countries. The safety and efficacy data on traditional medicine are far from sufficient. Lack of research data are mostly due to a lack of adequate or accepted research methodology for evaluating traditional medicine.

Safety, Efficacy and Quality Quality control Good Agricultural and Collection Practices for medicinal plants Updating Quality Control Methods for Raw Materials of Medicinal Plants Updating GMP guidelines for herbal medicines Contaminants and residues Safety Developing Guidelines for Safety Monitoring and pharmacovigilance of Herbal Medicines

Rational Use WHO developing training guidelines Training guidelines for chiropractic Training guidelines for manual therapies Osteopathy Chinese tui-na Shiatsu Judo-therapy Training Guidelines for Phytotherapy WHO Consumer Guidelines

WHO Traditional Medicine Strategy Policy: integrate TM/CAM with national health care systems Safety, efficacy and quality: provide guidance and support for effective regulation Access: ensure availability and affordability of TM/CAM Rational use: promote therapeutically-sound use of TM/CAM by providers and consumers

WHO support to countries 1. Production of tools, guidelines, protocols and monographs 2. Production of technical documents e.g. : Tools for institutionalizing TM in health systems Collaboration between THPs and CHPs Policy guidance and legal framework for the protection of Intellectual Property Rights and traditional medicine knowledge Regulation of practitioners, practices and products Modules for training health sciences students Modules for training THPs 3. Provision of technical/financial support to countries 4. Support strengthening of capacities for policy development and implementation, R&D and evaluation of TM safety, efficacy and quality; 5. Facilitate networking and information exchange