Chapter Six: Medical Pluralism:

Traditional and Modern Health

Care
In all societies, there are alternative or
complementary health care systems.
However, in modern societies,
biomedicine that claims to be
evidence-based dominates the
health systems.
This is why other systems are often
referred to as complementary or
alternative medicine.
CAM often predates modern medicine;
it comprises ways or practices
used in medical care before the
introduction of modern medicine
 …cont’d
 The term medical pluralism is used to
describe the coexistence of
biomedicine and alternative medicine.
 Therefore, medical pluralism (MP) refers to
the coexistence in a society of differing
medical traditions, grounded in different
principles or based on different world-
views
 MP can be defined as the adoption of more
than one medical system or the use or
integration of both conventional
biomedicine and CAM for health and illness
…cont’d
Apart from modern medicine that is
derived from scientific knowledge,
there are other numerous medical
traditions which are grouped as CAM.
This includes various forms of
traditional medicine such as herbal
medicine, acupuncture, chiropractic,
and osteopathy.
Alternative medicine refers to a
medical tradition often devoid of
systematic and scientifically
verifiable evidence, which people
sometimes use in the treatment and
prevention of diseases.
…cont’d
 Alternative medicine is usually
derived from historical and cultural
traditions.
 On the other hand, complementary
medicine is the phenomenon of the
mix of modern and traditional
medicines.
 In this case, traditional medicine is
used alongside orthodox medicine.
 This is why complementary medicine
is sometimes referred to as
integrative medicine.
…cont’d
CAM a group of diverse medical
and health care systems,
practices, and products that are
not generally considered part of
conventional medicine.
Conventional medicine (also
herein called modern, western,
biomedicine, orthodox, or allopathic
medicine) is medicine as practiced by
those who are formally trained in
biomedical sciences.
These people include the physicians,
pharmacists, nurses, and other allied
health professionals, such as physical
therapists and psychologists.
 …cont’d
Alternative medicine is usually
derived from the cultural worldview
of the people it serves.
This is why there are countless types
that are specific to particular ethnic
and religious groups (e.g., Chinese,
Korean, Ethiopian, Yoruba, and Zulu
traditional medicines).
The conception of health and illness
often varies within the systems.
In pluralistic medical systems, there
are divergent sickness labels
and multiple interpretations of
illness conditions.
…cont’d
 Alternative medicine and its existence
provides options in health care
 There is still a preference for alternative
medicine among many individuals in
both developing and developed
countries.
 In most societies, there is competition
between modern and alternative
medicine in the care of the patients.
 In most instances, they are closer to
community members than the orthodox
medical practitioners.
 And importantly, modern medicine has
not been able to resolve all health
problems, and alternative medicine often
claims to fill the gap
The Birth of Biomedicine
 The emergence of biomedicine is very
much bound up with a growing broader
sociopolitical reliance on science and its
methodological emphasis on the
empirical investigation of natural and
social phenomena for the purpose of
ensuring the social good.
 Biomedicine can be characterized as a
scientific system of medical practice
which from the 17th century onwards
replaced dominant religious and
magical ways of thinking about and
dealing with health and illness
 Part of a much wider shift to rationality
associated with the enlightenment and
the ‘march of progress’
 …cont’d
 From the mid-19 century onwards, the
biomedical approach towards the body
had established the laboratory as the
site where the dissection of corpses and
the application of new medical
technological instrumentation, such as
the agar plate, the X-ray and the
stethoscope, meant medical research
scientists were able to establish the
causes of infectious diseases that had
haunted civilization for as long as
recorded human history.
 By the end of the nineteenth century,
cholera, tuberculosis, typhoid and
diphtheria had been identified,
examined and catalogued.
The Development of the Hospital as
a Social Institution
The hospital, the major social institution
for the delivery of health care, offers
considerable advantages to both
patient and society.
From the standpoint of the individual,
the sick or injured person has access to
centralized medical knowledge and the
greatest array of technology in
hospitals.
From the standpoint of society,
hospitalization both protects the family
from many of the disruptive effects of
caring for the ill in the home and
operates as a means of guiding the sick
and injured into medically supervised
institutions where their problems are
…cont’d
The development of hospitals as
institutions providing medical services
for the general public proceeded in
pace with prevailing needs, beliefs,
values, and attitudes of the societies
they served
This is seen in the evolution of the
hospital's role in society over time.
Historically, hospitals have passed
through four distinct phases of
development:
(1) as centers of religious practice;
(2) as poorhouses;
(3) as death houses; and
 Physicians
A physician, medical practitioner,
medical doctor, or simply doctor, is a
professional who practices medicine,
which is concerned with promoting,
maintaining, or restoring health through
the study, diagnosis, prognosis and
treatment of disease, injury, and other
physical and mental impairments.
 The health care industry is usually
subordinate to their professional
authority in clinical matters.
 Medical doctors generally control
clinical work and the efforts of most
other people who provide health care
directly to patients.
 Consequently, the status and prestige
accorded to the physician is high
The Professionalization of the
Physician
 The social importance of the medical
function and the limited number of
people with the training to perform as
physicians are not the only criteria
explaining their professional status.
 William Goode (1960) noted that two
basic characteristics are sociologically
relevant in explaining professionalism:
(1)prolonged training in a body of
specialized and abstract knowledge
and
(2)an orientation toward providing a
service
 The Physician in a Changing
Society
 Public attitudes toward the medical profession
have shifted away from the unquestioning
acceptance of physician authority as
seen in the mid-twentieth century to a more
questioning and critical view of doctors today
 By the mid-twentieth century, the medical
profession stood at the height of its
professional power and prestige, enjoying
great public trust.
 This was a time referred as the "golden age"
of doctoring,
 Professional dominance theory accounts
for an unprecedented level of professional
control by doctors over health care delivery
 Proliferation of unnecessary tests,
hospitalizations, prescriptions, and surgical
operations
 …cont’d
 At the beginning of the twenty-first
century, however, we are witnessing a
profession in decline, and professional
dominance is no longer an adequate
theory
 The term countervailing power
shows how the medical profession is
one of many powerful groups in
society-the state, employers paying
for health insurance for their
employees, patients as consumers of
health care, and the medical-industrial
complex as producers of products and
services for profit-maneuvering to fulfill
…cont’d
Health insurance companies are also
a major power in health care
delivery, as they determine who gets
insurance coverage and what health
conditions are covered

Over time, the medical profession's

control over its market faltered as
these countervailing powers
established powerful positions as well
and ended the profession‘s
monopoly.
 The Deprofessionalization of
Physicians
Increased consumerism on the part of
patients and greater government and
corporate control over medical practice
have resulted in the decline of the
professional status of physicians.
 That is, doctors are moving from being
the absolute authority in medical
matters toward having lessened
authority.
With many patients insisting on greater
equality in the doctor-patient
relationship and corporate health
organizations that employ doctors
seeking to control costs, maximize
profits, and provide efficient services
that are responsive to market demand,
physicians are caught in the middle.
…cont’d
 Deprofessionalization is defined as "a
decline in power which results in a
decline in the degree to which
professions possess, or are perceived to
possess, a constellation of
characteristics denoting a profession."
 Deprofessionalization essentially means
a decline in a profession's autonomy
and control over clients.
 In the case of physicians, they still
retain the greatest authority in medical
affairs but that authority is no longer
absolute, and medical work is subject to
greater scrutiny by patients, health care
organizations, and government
agencies.
 TM in Africa
Medical pluralism is a major feature of
the health care system in African
societies
• There are as many traditional
medicines (TM) as there are societies
in Africa.
• Every ethno-religious group develops
peculiar medical practices and beliefs
based on historical and cultural
development.
• TM is a comprehensive term used to
refer to systems such as traditional
Chinese medicine, Indian Ayurveda,
Arabic unani medicine, African
medicine, and other forms of
indigenous medicine
 …cont’d
• The WHO has come to recognise TM as a
part of the care system in global health
care.
• Traditional medicine, also referred to as
indigenous or folk medicine
• TM is defined 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”
• Such knowledge and experience are
passed from one generation to the next
and could be preserved in writing or
Basic features of TM
1.TM uses physical materials in health
care, which may include herbs and
animal parts.
2.Traditional medicine has spiritual
aspects.
3.TM is not scientific or amenable to
science.
4. Traditional medicinal methods are
derived from the worldview of a society.
5. TM knowledge and practices are
passed from one generation to the next.
6. Traditional medicine is based on
experience, not experiments.
 Categories of Traditional
Healers
• There are a number of categories or
specialties in traditional medicine.
• Often, the different specialties work
together to ensure better health
outcomes.
• Some of these specialties include
• Herbalists
• Diviners
• Traditional birth attendants
• Traditional surgeons
• Traditional medicinal ingredient sellers
• Traditional bonesetters
• Traditional psychiatrists
• Faith-based healers
 Determinants of Utilization of
TM
• In many African countries, a substantial
majority of the population depends on
TM for primary care.
• Traditional healers are available in large
numbers, serving various communities
in resource-constrained societies
where modern health care is limited.
• There is a growing demand for TM
across African countries and even in
western countries
• Some of their medicines may be
efficacious and a few modern drugs are
derivatives of the herbs used by the
herbalists.
Determinants of the Use of
TM
Shortcomings of Traditional
Medicine
Traditional medicine is not entirely
amenable to science.
Within traditional medical practice,
there is no regulation of entry and exit.
A majority of the TM practitioners still
use traditional procedures and
equipment
From a biomedical point of view, TM
practice is devoid of procedural and
objective diagnosis.
There is no standardization of practice
The physical environment might be
poor, equipment not sterilized, and
personal hygiene might not be
HARMONIZING TRADITIONAL AND
MODERN MEDICINE
 Large proportion of the population in
Africa use traditional medicine as a
primary means of care.
 Traditional medicine will continue to
exist as a separated medical system for
some time.
 It was noted that many users of
traditional remedies also use modern
medicine at the same time.
 Many medical doctors apply both
traditional and modern medicine.
 Harmonization of traditional and
modern medicine will, therefore, ensure
that the two approaches work
Degree of Integration
The WHO has defined three types of
health system to describe the degree
to which TM/CAM is officially recognized
part of the national health system:
Integrative systems: TM/CAM is
officially recognized and incorporated
into all areas of health care provision.
Inclusive systems: recognize
TM/CAM, but has not yet fully
integrated it into all aspects of health
care.
Tolerant systems: the national health
care system is based entirely on
biomedicine, but some TM/CAM
practices are tolerated by law.