In many developing countries - as often stated in government reports - the majority of the population continues to use TM to meet its primary health care needs (Figure 1). Similarly, the resolution on Promoting the Role of Traditional Medicine in Health Systems: A Strategy for the African Region, adopted by the 50th WHO Regional Committee for the African Region in August 2000, states that about 80% of the population of African Member States use TM to help meet health care needs.² This includes use of traditional birth attendants (TBAs). In fact, recognizing the contribution that TBAs can make to primary health care, a number of African countries have initiated training programmes to improve TBAs' skills and primary health care knowledge (Figure 2). Some of these countries also provide training in TM for pharmacists, doctors and nurses.

Figure 1. Use of TM for primary health care is extensive in some developing countries

Sources: compiled from government reports to World Health Organization.

Figure 2. African countries with health care training programmes for traditional birth attendants

Source: World Health Organization, 2000.³

Table 2 Examples of countries with an integrative approach to TM/CAM

Sources: compiled from government reports to World Health Organization.

Table 3. Examples of countries with an inclusive approach to TM/CAM

Sources: compiled from government reports to World Health Organization.

In many Asian countries TM continues to be widely used, even though allopathic medicine is often readily available. In Japan, 60 - 70% of allopathic doctors prescribe kampo medicines for their patients. In Malaysia, traditional forms of Malay, Chinese and Indian medicine are used extensively. In China, TM accounts for around 40% of all health care delivered, and is used to treat roughly 200 million patients annually.⁴ For Latin America, the WHO Regional Office for the Americas (AMRO/PAHO) reports that 71% of the population in Chile and 40% of the population in Colombia have used TM.⁵

In many developed countries, certain CAM therapies are very popular. Various government and non-government reports (Figure 3) state that the percentage of the population that has used CAM is 46% in Australia, 49% in France and 70% in Canada.^6,7,8 A survey of 610 Swiss doctors showed that 46% had used some form of CAM, mainly homeopathy and acupuncture. This is comparable to the CAM figure for the Swiss population as a whole.⁹ In the United Kingdom, almost 40% of all general allopathic practitioners offer some form of CAM referral or access.¹⁰ In the USA, a national survey reported in the Journal of the American Medical Association indicated that use of at least 1 of 16 alternative therapies during the previous year increased from 34% in 1990 to 42% in 1997.¹³ The number of visits to CAM providers now exceeds by far the number of visits to all primary care physicians in the US.

Figure 3. Percentage of population which has used CAM at least once in selected developed countries

Sources: Fisher P & Ward A, 1999; Health Canada, 2001, World Health Organization, 1998.^7,8,6

Figure 4. Countries where acupuncture is practised by allopathic doctors only, or by both allopathic doctors and acupuncturists

Sources: World Federation of Acupuncture-Moxibustion Societies, 2000; World Health Organization, in press.^11,12

Acupuncture is especially popular. Originating in China, it is now used in at least 78 countries and practised not only by acupuncturists, but also by allopathic practitioners (Figure 4). According to the World Federation of Acupuncture-Moxibustion Societies, there are at least 50 000 acupuncturists in Asia. In Europe, there are an estimated 15 000 acupuncturists, including allopathic doctors who also practise as acupuncturists. In Belgium, 74% of acupuncture treatment is administered by allopathic doctors. In Germany, 77% of pain clinics provide acupuncture. In the United Kingdom, 46% of allopathic doctors either recommend patients for acupuncture treatment or treat their patients with acupuncture themselves. The USA has 12 000 licensed acupuncturists - the practice of acupuncture is legal in 38 states and six states are developing acupuncture practice policies.^11,14,15

Table 4. Increase in sales of the most popular herbal products in the USA 1997 - 1998

Source: data from Scanner Data, FDM, Inc., USA.¹⁸