Out-of-date statistics and traditional healers
It has been widely documented in the scientific literature, official fact sheets, reports and the press, that 80% of people in Asian and African countries (or sometimes: 80% of the world’s population) use traditional medicine practitioners to meet their primary healthcare needs. This statistic has also been used in policy-making and in defense of traditional, complementary and alternative medicine.
However, when my team at Warwick Medical School analysed representative survey data collected by the WHO from 6 middle-income countries, we found that the percentage of people reporting use of traditional medicine was much lower. At first we thought there must be something wrong with the data or our analysis. However, when we investigated this further we found that there were other reports similar to ours. We also found a blog post that traced the 80% statistic and found that it is likely to have originated in a World Health Organisation (WHO) textbook published in 1983, with the original data on which it was based now lost.
Our analysis of survey data found that, of the countries examined, use of traditional medicine was reported most frequently in India, where 11.7% of people reported that they usually visited a traditional healer when they had needed health care, over the past 3 years. Less than 3% reported that they usually visited a traditional healer when they needed health care in China, Ghana, Mexico, Russia and South Africa. When asked about health care use in the last 12 months, 19% of participants in India said they had consulted a traditional healer compared to 9.4% of the participants in China. In Ghana, Mexico, Russia and South Africa this statistic was less than 2%. We also found that those who used traditional medicine were different from those who used modern medicine. In China, traditional medicine users were rural and had worse self-reported health and more arthritis. In Ghana and India traditional medicine users were poorer and had more depression and high blood pressure.
In our research we were only able to examine 6 middle-income countries (of which just 4 were in Asia and Africa) and it is possible that the survey wasn’t able to identify all the use of traditional medicine. One possibility is that participants didn’t admit to using traditional healers when questioned for the survey, perhaps in order to appear progressive (this is known as social desirability bias). We don’t know what percentage of people rely on traditional medicine in low income countries and other middle income countries? We also don’t know whether the people who did report using traditional medicine did so because they had no other choice (for example, because modern medicine was unavailable) or whether traditional medicine is found to be more helpful than modern medicine for some people or for specific medical conditions.
In some low- and middle-income countries, there may not be enough medically qualified doctors and nurses, or other resources to provide a fully functional modern health care service. Where this occurs, traditional medicine and its practitioners are considered an important source of health care for the population. Integration of traditional medicine and modern medicine has been recommended by the WHO since 1978. This policy position is based on an assumption of widespread use of traditional medicine, this may need revision if it is confirmed that use of traditional medicine is low and/or declining, especially when there are reasons to doubt its effectiveness (and even its safety) in comparison to modern medicine.
University of Warwick Medical School, Gibbet Hill Campus, Coventry, UK
Use of traditional medicine in middle-income countries: a WHO-SAGE study.
Oyebode O, Kandala NB, Chilton PJ, Lilford RJ
Health Policy Plan. 2016 Mar 30