Bulletin of the World Health Organization最新文献

The health of Indigenous Peoples around the world is tied to longstanding Indigenous knowledge practices and access to Indigenous traditional medicine systems. Indigenous communities continue to have concerns, however, about their ability to ensure intergenerational transfer of Indigenous traditional medicine knowledge. These concerns stem from the continued lack of Indigenous rights as a result of colonization, a lack of protection of land rights and different levels of Indigenous self-determination around the world, all of which affect traditional medicine access and practices. Indigenous Peoples' access to their traditional medicine systems will therefore continue to depend on their access to self-determination, land and cultural rights, as well as on Indigenous data sovereignty. A balanced approach to Indigenous health and well-being is needed that prioritizes Indigenous traditional practices, community involvement, and Indigenous cultural and language revitalization (with support for ongoing intergenerational knowledge transfer). These elements are important for bringing back ecological harmony to Indigenous Peoples, communities and the planet. Additionally, with sufficient resources and support, Indigenous Peoples and their concepts of health can be a blueprint for harmony for people and health systems more widely, with Indigenous Peoples being a key determinant of planetary health. We outline some key points to ensure that the concepts of health and well-being of Indigenous Peoples and their Indigenous traditional medicine systems are maintained going forward for individual, community and planetary health.

Objective: To explore the integration of traditional and complementary medicine in health systems and identify the enablers and barriers to the process.

Methods: We searched PubMed®, Embase, Web of Science, Latin American and Caribbean Health Sciences Literature, China National Knowledge Infrastructure and WanFang Database for original research on integration of traditional and complementary medicine in health systems published from 1 January 2001 to 27 January 2025. We focused on low- and middle-income countries. We made a thematic analysis to identify the enablers of and barriers to integration. We mapped factors according to the six blocks of health-care systems: service delivery; health governance and financing; medical products; health information systems; health workforce; and service standards.

Findings: We included 43 publications from 19 countries, with 55.8% (24/43) from countries in the African Region. Traditional and complementary medicine had the potential to strengthen various aspects of health systems, particularly in health-service delivery and products. We identified 11 determinant domains which could act as both an enabler of and barrier to integration. The most commonly mentioned determinants influencing integration of traditional and complementary medicine were policies and finance, resource availability, and efficacy, quality and safety.

Conclusion: Our findings highlight the role of policies and finance in supporting integration of traditional and complementary medicine, and the need to ensure the quality and safety of traditional products through scientific methods. Reforms in medical education and strategic resource allocation are needed to create the necessary conditions for successful integration of traditional and complementary medicine.

Objective: To explore the global research funding landscape for traditional, complementary and integrative medicine.

Methods: We conducted a three-part study to assess the global research funding landscape. First, we searched the Dimensions database and online sources using Microsoft Copilot and Google between 12 November 2024 and 22 January 2025 for relevant grants. Second, we analysed national research infrastructure using World Health Organization (WHO) data, verified by regional contacts (14 January-28 February 2025). Third, we appraised selected funders across WHO regions, evaluating funding schemes for innovation, capacity-building and alignment with traditional medicine paradigms.

Findings: We identified 39 927 grants in the Dimensions database, with funding data available for 27 019 grants totalling 24.5 billion United States dollars (US$) for the years 1960 to 2024. Most grants (42.6%; 11 548) were valued under US$ 100 000, and half had a duration of 2-4 years. Cancer and cardiovascular diseases accounted for over half (8385/15 273) of topic-categorized grants, receiving US$ 5.8 billion and US$ 2.2 billion, respectively. Funders were concentrated in the Region of the Americas, and European and Western Pacific Regions. Only seven countries had schemes explicitly funding research for traditional, complementary and integrative medicine. Case study analysis of 40 schemes across 12 countries revealed limited support for traditional medicine paradigms, with few schemes meeting criteria for innovation, capacity-building or sensitivity to traditional knowledge systems.

Conclusion: Funding for traditional medicine research remains disproportionately low relative to its global use. Strengthening support from research funding agencies is essential to achieving the goals of the WHO Global traditional medicine strategy 2025-2034.

Objective: To evaluate the quality of global headache guidelines regarding the recommendation of acupuncture for migraine treatment.

Methods: We searched 31 electronic databases and 15 guideline repositories from inception to October 2024, without language restrictions. We identified 25 guidelines meeting our inclusion criteria, and evaluated these for methodological, reporting and recommendation quality using the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument, Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist, and AGREE Recommendations Excellence (REX) tool, respectively. We present our findings using descriptive statistics, and assess interrater reliability using intraclass correlation coefficients.

Findings: Of the 25 guidelines analysed, we observed that 40.0% (10/25) recommended acupuncture and 32.0% (8/25) provided conditional recommendations. Of the 18 guidelines recommending acupuncture, 77.8% (14/18) lacked procedural details; only 22.2% (4/18) specified treatment frequency and 16.7% (3/18) described needling techniques. We found that methodological quality was suboptimal, with the domain clarity of presentation scoring highest (75.2%) and applicability lowest (20.3%). We noted that reporting quality was inadequate, particularly in the review and quality assurance domain (18.8%). Only 4.0% (2/25) of guidelines provided high-quality acupuncture recommendations. The 2023 World Federation of Acupuncture-Moxibustion Societies guideline achieved the highest overall quality.

Conclusion: Current global headache guidelines provide limited and inadequately detailed recommendations for acupuncture in migraine treatment, constrained by low methodological quality. Strict adherence to standardized reporting, methodological rigour and recommendation frameworks is essential to generate high-quality evidence, guide clinical decision-making and enhance the global acceptance of acupuncture therapy for migraine.

Traditional, complementary and integrative medicine plays an important role in global health-care systems. Despite its widespread use and recognition by more than 170 Member States of the World Health Organization, many disparities in regulation exist between countries. We conducted a comparative analysis of the regulatory frameworks governing traditional medicine products in six high- or middle-income countries or jurisdictions where traditional medicine is used extensively: Australia, Canada, China, Republic of Korea, United States of America and the European Union. We focused on marketing authorization pathways, approval standards and successful approvals. We found differences in regulatory approaches, with countries adopting either clinical study-based or traditional knowledge-based pathways which led to varying requirements for non-clinical and clinical evidence. While the European Union and the United States acknowledge historical human-use evidence, relatively rigorous clinical investigations are required. Australia and Canada consider historical human-use evidence in marketing authorization for products that do not require professional supervision. Recent regulatory reforms in countries such as China and the Republic of Korea aim to enhance regulatory supervision. Across all jurisdictions, fluctuations in the number of successful applications persisted amid evolving policy changes and regulatory requirements. To promote the worldwide use of traditional medicine products, a globally coordinated, tiered and risk-based international framework is needed to ensure the efficacy, quality and safety of traditional medicine products. This approach requires establishing stable (i.e. predictable and consistently implemented) regulatory systems, strengthening the evidence on traditional medicine products with both clinical and real-world data, and facilitating regulatory convergence through reciprocity and globally harmonized evaluation standards.

Nicole Redvers talks to Gary Humphreys about integrating Indigenous medicine and planetary health into global health discourse.