In November 2008, attendees at the first-ever World Health Organization (WHO) Congress on Traditional Medicine adopted the Beijing Declaration. Heralded as the most significant outcome of the Congress, the Declaration promotes the safe and effective use of traditional medicine (TM), while guiding and supporting its integration into national healthcare systems around the world.¹

“The Declaration may be World Health Organization’s most significant initiative on traditional medicine to date,” said Ryan Abbott, a researcher at the University of California at Los Angeles (UCLA) Center for East–West Medicine, who attended the Congress as a member of the WHO Secretariat and is a former member of WHO’s TM team (oral communication, May 8, 2009). “More than ever now, many countries are promoting progressive policies towards alternative medicine. I don’t think you would have seen something like the Declaration 10 years ago.”

The Declaration suggests for the governments of WHO Member States to do the following:¹

• respect, preserve, promote, and communicate TM;
• create national policies, regulations, and standards within national health systems to ensure safe and effective use of TM;
• integrate TM into national health systems;
• further develop TM based on the “Global Strategy and Plan of Action on Public Health, Innovation, and Intellectual Property,” adopted at the 61^st World Health Assembly in 2008;²
• establish systems for the qualification, accreditation, or licensing of TM practitioners;
• strengthen communication between conventional medicine and TM providers and establish training programs for health professionals, medical students, and researchers.

Six months after the Beijing Declaration was adopted, a resolution on TM was passed by the 62^nd World Health Assembly (WHA), the supreme decision-making body for WHO.³ The resolution is heavily based on the Beijing Declaration, acknowledges the Declaration in its text, and calls for Member States to consider adopting and implementing the Declaration in accordance with their own national capacities, priorities, relevant legislation, and circumstances, said Xiaorui Zhang, MD, the coordinator of WHO’s TM Program (oral communication, June 8, 2009).

“Since the resolution was adopted by all Member States during the WHO Health Assembly in May 2009, it is more powerful than the Declaration, which was agreed upon by the representatives of 74 countries,” Dr. Zhang added.

WHO has a 3-decade history with TM, including the historic 1978 Alma-Ata Declaration, which was the organization’s first recognition of TM’s importance and how it affects primary healthcare.⁴ WHO has claimed that up to 70-80% of the population in developed and developing countries have used TM or complementary and alternative medicine (CAM).⁵ The organization has also published various guidelines and monographs concerning quality, safety, and efficacy of medicinal plants and herbal preparations.^6,7

Still, the Beijing Declaration stands out among other components of WHO’s TM history, said Gerry Bodeker, EdD, a senior clinical lecturer in public health at Oxford University, chair of the Oxford-based Global Initiative For Traditional Systems (GIFTS) of Health, and co-editor of the 2005 WHO Global Atlas of Traditional, Complementary and Alternative Medicine (e-mail, June 2, 2009). The 2008 Beijing Declaration advances the most comprehensive set of policy recommendations that go beyond the clinical emphasis of previous positions, he said.

In order for the Declaration’s policies and practices to become entrenched and endure, further actions are needed, such as the regulation of TM practices and practitioners, adequate financing, and TM economic research, said Dr. Bodeker. Though WHO has great influence, it does not have authoritative powers, requiring any outcomes of the Declaration to result from a range of actions from governments, non-governmental organizations, TM practitioners and associations, and international networks, he added.

“Ultimately, the ball is back in the court of national governments to make the big decisions to mainstream and fast track—or not—traditional medicine and integrative healthcare,” said Dr. Bodeker. “What is certain is that the Declaration urges those governments that are lagging in their development of this field to move ahead to catch up with the rest of the world.”

Some nations are taking the initiative to proceed. On April 21, 2009, the State Council of China released its “Guidance to Support and Promote the Development of Traditional Chinese Medicine (TCM),” which requests that TCM services be included in all levels of health services and covered by all kinds of health insurance.⁸ The State Council also requested that the country’s TCM pharmaceutical industry be improved and that all levels of local government increase investment in TCM public hospitals and support research and training of TCM doctors, said Zhu Haidong, who works in the Department of International Cooperation of State Administration of TCM (e-mail, June 11, 2009).

Other entities have not necessarily changed their actions as a direct response to the Declaration but are continuing with TMrelated programs already in place or being planned. The Japanbased Nippon Foundation, for example, is an important partner of WHO’s TM department and has several TM-related projects underway, such as its collaboration with governments of countries like Myanmar and Thailand to distribute TM kits.⁹ Nippon’s future projects include a 5-year collaboration with the Association of Southeast Asian Nations (ASEAN) Secretariat for the promotion of TM throughout the region, as well as the creation of curriculum and funding for Cambodia’s first TM school.

“The Declaration itself does not affect our projects,” said Tatsuki Nakajima, who oversees Nippon’s TM program (e-mail, May 11, 2009). “Instead, the Declaration could prove to be the meaning of our projects.”

Additionally, for the African Region of WHO, which is midway through the African Decade for the Development of Traditional Medicine, the Beijing Declaration further reinforces their commitment to make TM a priority within the context of rational use, safety, and professional development, said Dr. Bodeker.

The National Center for Complementary and Alternative Medicine (NCCAM), a division of the National Institutes of Health in the United States and a WHO collaborating center for TM, also feels that its projects are in accordance with the Declaration. Jack Killen, Jr., MD, deputy director of NCCAM, noted that the Declaration calls for research to develop an evidence base for complementary, alternative, and traditional medicine (e-mail, May 22, 2009).

“In this regard, the Declaration is entirely consistent with the existing mission, programs, and operations of NCCAM,” said Dr. Killen, adding that NCCAM’s research informs policy and healthcare coverage decisions made by governmental and corporate entities.

Though the Declaration is an advocacy document and cannot require countries to act, it will influence future TM negotiations at WHO, said UCLA’s Abbott. Abbott added that he expects it might take years before WHO would require member countries to commit themselves to certain activities.

“This may be the first step to something like a legally-binding agreement.”

A compulsory agreement would call for great motivation and initiative from Member States, and as far as he knows, there is no push for such a commitment, said Abbott. Part of this is due to complicated issues, such as TM regulation, groups’ rights to protect their natural resources, and intellectual property rights, on which developed and underdeveloped countries tend to disagree, he continued.¹⁰

Future promotion of TM by WHO, however, will have to come about under new leadership. Dr. Zhang, who has been the leader of WHO’s TM program for nearly 20 years, will soon retire. Dr. Zhang maintains her strong belief in TM and the importance of an integrative relationship between TM and Western medicine.

“I was a ‘barefoot doctor’ in a rural area for 5 years. I used herbs and acupuncture on the patients and I’ve seen it work,” Dr. Zhang said. “I have big hopes for traditional medicine because the people need it and it works. We need to do more research on its safety, efficacy, and quality to ensure that the patient benefits.”

—Lindsay Stafford

References

1. Beijing Declaration. World Health Organization Web site. Available at: http://www.who.int/medicines/areas/traditional/congress/beijing_ declaration/en/index.html. Accessed April 29, 2009.
2. World Health Organization. Sixty-first World Health Assembly. Global strategy and plan of action on public health, innovation and intellectual property. WHA 61.21. Agenda Item 11.6. May 24, 2008.
3. World Health Organization. Sixty-second World Health Assembly. Traditional Medicine. WHA 62.13. Agenda Item 12.4. May 22, 2009.
4. Background of WHO Congress on Traditional Medicine. World Health Organization Web site. Available at: http://www.who.int/ medicines/areas/traditional/congress/congress_background_info/en/ index.html. Accessed April 29, 2009.
5. Traditional Medicine. World Health Organization Web site. Available at: www.who.int/mediacentre/factsheets/fs134/en/index.html. Accessed July 6, 2009.
6. Akerele O. Summary of WHO guidelines for the assessment of herbal medicines. HerbalGram. 1994;28:13.
7. Blumenthal M. Herbal monographs. HerbalGram. 1997;40;30.
8. China introduces traditional medicine into basic healthcare program. Xinhua News Agency. May 7, 2009. Available at: http://news.xinhuanet.com/english/2009-05/07/content_11332281.htm. Accessed May 11, 2009.
9. Sasakawa Y. World Congress speech. Lecture presented at: World Health Organization Congress on Traditional Medicine; November 7–9, 2008; Beijing, China.
10. Abbott R. The Beijing Declaration: A landmark for traditional medicine. Bridges. International Centre for Trade and Sustainable Development. 13(1); March 2009.