Director, Division of Health Sector Development, Western Pacific Region, World Health Organisation
Responsible for the Division of Health Systems at the regional office and for technical support to countries and WHO country offices in a wide range of health system issues, including universal health coverage, health policy and planning, health financing, health workforce, health information systems, health system research, pharmaceuticals, medical technologies, traditional medicine, service delivery and quality, health law and regulation, and community engagement. Cross-cutting issues covered in the division include sustainable development goals, social determinants of health, equity, human rights and gender. Dr Vivian has more than 30 years' experience in health policy and program development, health planning, and public health teaching and research. She was previously Professor of Public Health and Head of the School of Public Health at La Trobe University, in Melbourne, and is the author of several leading public health textbooks in Australia and numerous articles on health issues in Australia, China, and globally. Vivian has also worked at senior levels in health policy in several Australian jurisdictions and in intergovernmental relations, including as Executive Officer of the National Public Health Partnership. She has also consulted widely for the World Bank, UK Dept for International Development, AusAID as well as the WHO, and served on multiple academic, government, community and editorial boards.
The integration of traditional medicine in health care has often been challenged by the notion of ‘evidence’. In recent years, the discourse and advocacy for integration of traditional medicine with mainstream health systems has become more prominent with the adoption of universal health coverage as a global aspiration for all countries. This is reflected in the WHO Global Strategy for Traditional Medicine. The country level, however, the meaning of, and the drivers for, integration vary. The policy pathways are, therefore, complex to navigate, and raises the question of the nature of evidence required for policy-making. This talk will consider the meaning and drivers of debates about ‘evidence’ and ‘integration’, and in reviewing selected developments in countries in the Western Pacific Region, discuss what evidence matters for policy-making. Some suggestions will be made about the types of research that matters and how to link research with policy and practice.
Professor Frances Rapport
Professor of Health Implementation, Australian Institute of Health Innovation, Macquarie University
Professor Frances Rapport is Professor of Health Implementation Science at the Australian Institute of Health Innovation, Macquarie University, and along with her team of Implementation Scientists, concentrates on the translation of research outcomes from health services research into practice. Frances’s work promotes the uptake of research findings into routine healthcare contexts, policy documents and organisational development. In addition, outputs from her research directly link to educational impact through the new Medical Doctorate Program at the Faculty of Medicine and Health Sciences, Macquarie University, to ensure rigorous mixed methods are embedded into research training and medical practice. Highlights from 2018 include: assessment of service use for complex epilepsy in New South Wales, leading to publications in BMJ Open and Epilepsy and Behavior; the reporting of patient and healthcare professional perceptions of risk in breast cancer, leading to publications in Qualitative Health Research and the latest Handbook of Research Methods in Health and Social Sciences; and funding from Cochlear Ltd to examine the needs and experiences of adults over 50 years of age with hearing health problems in relation to current service provision. IN 2018 Frances concluded a study with St Vincent’s Health Australia examining organisational patient-centred care practices, and was commissioned by the Australian Commission on Safety and Quality in Healthcare to evaluate sentinel events reporting in NSW and beyond.
Frances will examine the value and use of implementation Science and its relationship to Complementary Medical Research within the current healthcare climate. Defining what Implementation Science is and how it functions, she will discuss the ways in which Implementation Science is capable of translating research findings into useful, medical and healthcare applications to improve practitioner services and healthcare provision. By so doing, she aims to shine a light on the scope of Implementation Science within an historical and contemporary context. During the presentation a new Implementation Science model designed by Frances and colleagues will be introduced, and a number of challenges surrounding the implementation process and how they might best be overcome will be discussed. Frances will bring to the audience’s attention the importance of having ‘support on the ground’ to ensure research outputs have the necessary stakeholder buy-in. She will also discuss the need for interventions to be appropriately integrated into new healthcare and medical systems, to enhance complementary practitioners’ working practices, including screening and prevention. Ultimately, Frances will argue for rigorous research which, underpinned by theoretically sound implementation science, can be well prepared, with outcome-oriented, real-life goals.
Distinguished Professor Jon Adams
Director, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney
Jon is Distinguished Professor of Public Health at the University of Technology Sydney, Director of the Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), an ARC Professorial Future Fellow and a Fulbright Senior Future Scholar. Jon has attracted >$18M external funding and authored >430 publications to date. Under Jon’s Directorship, ARCCIM hosts the only program of critical public health and health services research of traditional, complementary and integrative medicine (TCIM) in the world currently leading >40 projects, housing >50 affiliated researchers and supervising the largest pool of TCIM PhDs (45) in Australia. His research interests include healthy ageing, chronic illness and the health of indigenous and other priority populations. Jon’s research has also led developments in health economics, practice-based research networks and implementation science and he has mentored >60 junior researchers receiving the prestigious PHAA National Mentor of the Year Award in 2017.
The translation of research findings into clinical practice and health policy is a significant challenge to the success of the evidence-based practice movement. Against this backdrop, implementation science (IS) – the study of methods to promote the integration of research findings and evidence into policy and practice – has become increasingly recognised as a discrete research field developing and refining distinct methodologies and conceptual frameworks. Unfortunately, to date IS has largely concentrated its efforts upon conventional (often hospital-based) settings and care and there has been little critical, rigorous consideration of this methodological and conceptual field with regards to traditional, complementary and integrative medicine/health care (TCIM). In this presentation Distinguished Professor Adams outlines the appropriation of IS to an examination of TCIM identifying potential opportunities and challenges for both TCIM and IS scholarship.
Dr Amie Steel
Associate Director Research, Endeavour College of Natural Health/Research Fellow, University of Technology Sydney
Dr Amie Steel is a naturopath, educator and researcher in the field of complementary medicine (CM). Amie currently holds dual research positions as a postdoctoral research fellow at the Australian Research Centre in Complementary and Integrative Medicine within the Faculty of Health at University of Technology Sydney, and also Associate Director – Research in the Office of Research at the Endeavour College of Natural Health. Amie has a PhD from the University of Technology Sydney. She has a leadership position in four practice-based research networks in Australian and New Zealand which includes Chair and Chief Investigator of the Practitioner Research and Collaboration Initiative (PRACI). She is a founding member of the Public Health Association of Australia Evidence, Research and Policy in Complementary Medicine Special Interest Group. Amie has attracted ~$1M in research funding in the last 2 years, is on the editorial board for a number of journals and is widely published in peer-reviewed journals, and edited books. Amie is a collaborator with the Australian Longitudinal Study on Women’s Health and has been a contributing researcher on a number of Australian Research Council funded projects. Her research interests include women’s health, CM curriculum development and delivery, integration and regulation of CM, and the interface between evidence-based medicine and CM practice.
Over the last 30 years complementary and integrative medicine (CIM) researchers and clinicians have faced challenges associated with expectations that the field meet the requirements of evidence-based medicine (EBM). In more recent years, the applicability of the EBM paradigm has been subject to its own criticisms as the importance of patient-centredness and real-world relevance have been juxtaposed against EBM principles. Through this presentation, Dr Steel will explore how CIM researchers have begun to incorporate an understanding of pragmatism, holism, and complexity in clinical research. Some of this presentation will draw on advances in clinical research methodology in health research more generally, others will propose areas that CIM may be leading health research innovation to answer real-world questions. The meaning and value of research that is based in practice, informed by practice and relevant to practice will be explored. Dr Steel will draw on the program of research she has helped advance in Australia and New Zealand through ARCCIM and Endeavour College of Natural Health, with a focus on a number of national and international practice-based research networks for CIM professions.
Dr Islandia Maria Carvalho De Sousa
National Observatory of Traditional Knowledge and Integrative and Complementary Practices in Health and Fiocruz, Brazil
Assistant Researcher and lecturer at the Aggeu Magalhaes-Oswaldo Cruz Foundation. Coordinator of the research group Knowledge and Practices in Health-Fiocruz/PE, with research and publication in the REA OF Medical Rationalities and Integrative Practices. Vice-coordinator of the research group in Political Economy of Health-UFPE. Member of the Board of Directors of the Brazilian Association of Health Economics and the Thematic Group on Integrative Practices of the Brazilian Association of Health Economics. Graduated in nursing with master’s and doctorate degrees in Public Health. Specialist in Acupuncture, in Body Therapies and n Health System Management. With more than 20 years’ experience with integrative practices and popular medicine.
In Brazil, since 2015, a national database has been created to collect data about care performed in Primary Health Care in all Brazilian municipalities. In 2017, the system became mandatory for federal government funding, approaching close to 100% compliance in a universe of 5570 municipalities. Municipalities must registertheir data to the national database from a free public technology solution called E-SUS. Currently, this information is provided exclusively by services linked to the Brazilian Unified Health System (SUS), with prospects for an integration with private services into the national database. Among the information provided by the municipalities to the national base there is a section to inform about the offer of Traditional Complementary and Integrative Medicine (TCIM), which is locally known as Integrative and Complementary Practices in Health (Práticas Integrativas e Complementares em Saúde – PICS). There are 29 PICS recognized by the Ministry of Health: homeopathy; Traditional Chinese Medicine; anthroposophic medicine; social termalism/crenotherapy; medicinal plants and herbal medicine ;art therapy, ayurveda, biodanza, laying on of hands, circular dance, meditation, music therapy, naturopathy, osteopathy, chiropractic, reflexology, shantala, integrative community therapy, family constellation, chromotherapy, aromatherapy, geotherapy, bioenergetics, apitherapy, hypnotherapy, reiki, flower therapy, ozonotherapy and yoga. Patient data is also available regarding the association with PICS such as : 1) professional who performed the care, 2) place of residence, 3) sex, 4) age, 5) motivation for the consultation or health complaint, 6 ) biomedical diagnosis, 7) type of consultation (emergency, urgency or routine), 8) location of the consultation (health service, place of residence or school), 9) conducts performed in the service (procedures, request for exams, referrals to specialized services). In the forthcoming years, Brazil will be able to offer big-data database to all Brazilian researchers, which will enable robust studies on the effectiveness of PICS’ use offered in SUS, considering both its quantitative and qualitative range of data.
Professor Alvaro Viljoen
Professor,Tshwane University of Technology/ National Research Chair in Phytomedicine/ Director, MRC Herbal Drugs Research Unit, South Africa
Professor Viljoen’s is a trained botanist with a research interest is the phytochemistry and biological activity of medicinal and aromatic plants indigenous to South Africa. His PhD was awarded from the University of Johannesburg on the chemotaxonomy of the genus Aloe. He has held the position of research fellow in the Department of Pharmaceutical Sciences, Tshwane University of Technology (Pretoria) since 2005. He has authored / co-authored >220 peer reviewed papers mostly on the phytochemical exploration and pharmacological activity of indigenous medicinal and aromatic plants. He is the Editor-in-Chief of Journal of Ethnopharmacology (Elsevier) and has been elected on to the editorial board of the Journal of Essential Oil Research (Francis & Taylor) and Phytochemistry Letters (Elsevier). He is also reviewing-editor for South African Journal of Botany (Elsevier). In October 2013 Alvaro was awarded the National Research Chair in Phytomedicine a position which he holds concurrently as Director of the SAMRC Herbal Drugs Research Unit in South Africa. More than eighty post-graduate students have graduated under his supervision since 2002.
Southern Africa harbours an impressive floral diversity and ranks as one of the most biodiverse countries in the world. Interweaved within this botanical tapestry is a cultural heritage characterised by rich indigenous knowledge systems (IKS) which have moulded one of the oldest healing modalities, African Traditional Medicines (ATM). This unique blend of medicinal plant use and IKS has created a unique research opportunity in enthnopharmacology. Over the past 20 years our group has endeavoured to provide a scientific rationale for medicinal plant use through an evidence-based research approach of traditional medicines. Several examples will be presented to demonstrate the challenging yet rewarding workflow to explore the chemistry and biological properties of the ethnomedicinal flora of South Africa. Using various in vitro and in vivo approaches, complemented by analytical methods and multivariate data analysis we aim to contribute to the fundamental research base required to convert these botanical assets into tangible consumer products. The various challenges facing translation research and the standardisation of ATMs will be highlighted.
Dr Francesca Panzironi
Aboriginal Traditional Medicine in today’s practice: a pathway of connections and interrelationships
Dr Francesca Panzironi is the founder and Chief Executive Officer of the Aṉangu Ngangkaṟi Tjutaku Aboriginal Corporation (ANTAC).
Dr. Panzironi is an international human rights academic who applied her knowledge and experience to create a platform for the recognition of the internationally recognized right of Indigenous Peoples to maintain and practice their traditional medicines within Australia' s national health care system.
Dr Panzironi has extensive experience as a researcher and lecturer in the areas of international human rights law, international studies, international and community development. She holds a PhD in Law (University of Sydney), a Master degree in Development and Cooperation (University of Pavia), and an Honor Degree in Political Science (‘La Sapienza’ University, Rome).
Dr Panzironi has presented her research and groundwork in numerous international and national conferences. Her work and achievements with the ngangkaṟi has been featured on national media, including SBS News, National Indigenous Television (NITV), The Point - NITV, ABC Radio, SBS Radio, Channel 7.
Aboriginal Traditional Medicine in Australia has been ignored for a very long time. Dr Panzironi will discuss the creation of a pathway of connections and interrelationships with the ngangkari – Aboriginal Traditional Healers – from the Aṉangu Pitjantjatjara Yankuntjatjara (APY) Lands in the far north-west of South Australia. This process led to the creation of the Aṉangu Ngangkari Tjutaku Aboriginal Corporation (ANTAC), the first organization of Aboriginal Traditional Healers in Australia, and continues to provide the indispensable foundations on which the 60,000 year-old Aboriginal traditional healing system is practiced today.
Dr Daniel Gallego-Perez
Dr. Daniel F. Gallego-Pérez is a physician with a specialty in alternative therapies, and a Doctor of Public Health candidate at Boston University. Since medical school, he has been interested in the range of possibilities that exist at the intersection of traditional, complementary, and integrative medicine and public health. He worked as a general practitioner and nutrition program coordinator in the Buduburam Refugee Camp, Ghana, between 2004 and 2008. He participated in the design and implementation of a pilot project to develop complementary medicine services in public hospitals in Bogota, Colombia, between 2009 and 2013. He has been consulting for the Pan American Health Organization since 2015, first at the country office in Nicaragua, and later at the regional office in Washington DC, where he assists health care systems strengthening and transformation processes, including the integration of traditional and complementary medicine. He is currently the chair-elect of the Integrative, Complementary, and Traditional Health Practices (ICTHP) Section of the American Public Health Association (APHA).
In Latin America, healing systems and practices that have most recently been referred to as “traditional, complementary, and integrative”, are as ever present today, as they have been in the past. They not only belong to the realm of “medicine,” they are ingrained in peoples’ daily lives. However, it has not been until recently that Latin American countries started to devote attention to this diversity of approaches. Countries have taken several paths to formally include non-biomedical approaches in their healthcare systems; these paths have taken the forms of constitutional changes, passage of legislation, creation of institutional norms, and development of public policies. Often, the policies and norms that countries have put in place, do not adequately reflect the practice realm within those countries, but rather reflect ad hoc political processes. This presentation seeks to contrast the practice-level reality of therapeutic pluralism in Latin American countries, with the political and legislative developments highlighting successes and shortcomings, and it seeks to discuss the role of research, or the lack thereof, in this ongoing process.
From New Zealand, Donna Kerridge (Ngāti Mahuta, Ngāti Tahinga, Ngāti Maniapoto) is a respected rongoā Māori practitioner. She is a passionate advocate for the protection of related mātauranga Māori (traditional Māori knowledge) and decriminalising Māori medical knowledges in the modern world. She is the authorised spokesperson for Te Kāhui Rongoā, the New Zealand national collective of rongoā Māori practitioners, with a membership base of more than 800. She regularly serves on Government expert advisory committees and as a Māori advisor for numerous tertiary research projects. Her work as a public commentator on health and environmental issues as they affect New Zealand Māori health and wellbeing is widely respected.
‘Any form of knowledge will only ever truly make sense within its own cultural context’, Philosopher Paul Feyerabend.
The cultures and traditional knowledge repositories researchers seek to protect and embrace can often result in their dilution or reformation making them unrecogonisable to their protectors. Oral traditions can be subject to significant loss in translation between cultures and different world views. For New Zealand Maori our healing traditions belong to the land in which that knowledge was seeded, Aotearoa. Protection from misappropriation and eventual loss was once the responsibility of pukenga (designated knowledge holders) that were supported by natural land and sea borders, now eroded in a digital world and global economy.
Combined with current legislation that imposes foreign values and a different set of health and safety concerns on our indigenous healing practices, the scene is set for a perfect storm, complete alienation from the gold that has sustained us for thousands of years in our challenging and ever changing environment.
Health and environmental researchers can help prevent further colonisation of indigenous cultures and the remaining strands of our indigeneity, that which we hold in our heads and dear to our hearts. By truly investing in understanding how indigenous peoples interpret their landscape will enhance the benefit research offers those of a different culture, those responsible for lifting indigenous health outcomes and most importantly our indigenous generations yet to be born.