Thursday, March 19, 2009

Role of homeopathy in community health

Preventive and Social Medicine or Community Health is emerging as a cementing force that is binding together medical care providers, health policy planners, government machinery and also the activist groups that are focussing on health related issues. The involvement of multiple stakeholders provides an understanding of how important community-based health issues are in the future of healthcare operations. The International Conference on Primary health Care, 1978, popularly called as Alma Ata Declaration lays stress on health being a fundamental human right. In this context, it is appropriate to examine the role of homeopathy vis-à-vis community health: whether these two entities are mutually compatible or is there a dichotomy in aligning these two.
Homeopathy, based on the operational principle ‘let likes be cured by likes’ is traditionally associated with an individualistic approach for therapeutic decision making. It is also a generally held understanding that every subject receiving homeopathy medicines has to be measured as an individual, applying the parameters of homeopathic pathometrics. These parameters include diagnostic profiling and personality profiling of each subject. This has become an integral and indelible routine in the homeopathic therapeutic decision making. Therefore, the populist interpretations of Hahnemann’s writings have revolved around the opinions that reinforce that homeopathy is customising prescriptions for the individual patients.

Community health, as a discipline, strives to provide health services in the community, understand community resources, promote health and prevent disease, empower communities with information on health related issues and promote community participation in healthcare activities among other issues. For achieving this, the community health strives to take into account the socio-cultural aspects of patient care, coordinate a community’s health resources for the care of patients, identify and intervene in a community health problem and assimilate into community and participate in its organisations.

Therefore, the approach of Community Health has is focused on preventive, promotive and therapeutic modalities for larger segments of society at any given time. The focus here is more inclusive of the society, than the single subject. In its quest for wider reach, community health trusts the opinion, ‘what is good for the population is good for the individual’. Thus, the operational principles of homeopathy and community health seem to be diametrically opposed and the popular image of homeopathy seems to be unsuited for its wider application in community health context.

However, this fallacy is as superficial as it can be. Scratch the history of homeopathy a little more deep; you will find that the greatest social impact that homeopathy has made, is in the ‘mass’ situations – be it the Asiatic cholera during Hahnemann’s time or the recent epidemics of Japanese Encephalitis in parts of India. It is another matter that the homeopathic profession has not completely showcased the good work it has done in the manner that could attract the attention of health policy makers to take position on the potential of homeopathy in community health context.

The corollary of the statistical significance of ‘what is good for mass is good for individuals’ could also be ‘what is good for one individual is good for another with the other circumstances remaining the same’. The second statement is the one that drives homeopathic materia medica. Thus, by deduction, homeopathy is compatible for ‘mass’ therapy.

Therefore, to explain the role of homeopathy in community health, we need to look for indications in interdisciplinary areas like Medial Sociology, Social Epidemiology, health geography and Multilevel Modeling. We may draw further inspiration from the research that is undertaken in the areas like ‘social model of health’. Medico sociological research on healthcare organization and policy can be focused on different levels – the macro, social level; the meso level of the formal organizational structure and the micro individual level.

Charles Mc lntire defined Medical Sociology in the late nineteenth century as the professional endeavour devoted to social epidemiology, study of cultural factors and social relations in connection with illness, and the social principles in medical organisation and treatment. Initially the medical professional endeavoured to develop it as a subsidiary discipline. However, it was the efforts of sociologists that developed medical sociology as an academic and research based discipline. Medical sociology concerns itself with the sociological study of the social institution of medicine, its knowledge, practice and effects. Medical sociologists investigate the social organisation and production of health and illness. They are also interested in the frontier areas of public health, demography, etc to explore phenomena at the intersection of the social and clinical sciences.

Social epidemiology is defined as "the branch of epidemiology that studies the social distribution and social determinants of health," that is, "both specific features of, and pathways by which, societal conditions affect health". The aim of social epidemiology is to identify socio environmental exposures that may be related to physical and mental health outcomes. The principal concern of social epidemiology is the study of how society and social organization influence the health and standard of living of individuals and populations.

Health geography is the interdisciplinary approach of applying geographical information to the study of health, illness and healthcare. Though it is based on the biomedical model of health, it is grounded in the empiricist ideology that stresses on observational evidence. This socio-ecological model takes a more holistic approach to health and illness. It emphasises on the treatment of whole person and not just components of the system.

Multilevel modeling is a process that applies parameters which vary at more than one level. The concept of levels is the critical factor in this process. Multilevel modeling has gained greater popularity due to the ease ushered in by computer technology and user friendly software applications. The goal of multilevel model is to predict values of some dependent variable based on a function of predictor variables at more than one level. For example, we might want to examine how a person’s health is influenced by the characteristics of an individual and the environment in which he / she lives.

Taking example of healthcare research, in the effort to assess the impact of two different therapies, one may have to take not only the response at individual level, but also at the environmental or other collateral levels. The data may be analysed for assessment of not only the individual level response, but also the levels of group response and responses of groups from various geographical distributions. These correlations must be represented in the analysis for correct inference to be drawn from the experiment.

To quote John Dewey, ‘I should venture to assert that the most pervasive fallacy of philosophic thinking goes back to neglect of context’. In the context of infectious disease treatment, it was observed and recorded by Thomas McKeown that improvement in living conditions, especially diet and housing, public sanitation and personal hygiene were also factored as important in eliminating the potential for infectious diseases. This contextualisation is also validated in homeopathy – from pathological response to individualised response to pathogenesis to constitutional flair that may transcend diagnostic criteria. Even in the modeling of human behaviour, context can be very important. Individual action may be determined by independent variables operating at different levels, from micro to macro.

A transdisciplinary approach by integrating areas of study like medical sociology, social epidemiology, health geography and multilevel modeling, to health and illness has resulted in contextualising health and society. In any phenomenon related to society and health, it has become necessary to impress upon the importance of context. Because of the human – social interaction is an open system consisting of variables that are diverse and perhaps beyond the control of external contextual influences, the application of multilevel modeling brings in a semblance of ‘organised thinking’. The biopsychosocial model developed by George Engel in the 1970s explains the convergence of various factors in the disease / disability generation. This demonstrates that characteristics or processes occurring at one level of analysis may have their effect on characteristics or processes at another level.

There is an increased interest and activity among the health policy researchers to understand the relevance of multilevel approach that could study the impact of the biopsychosocial model. The report prepared by the Office of Behavioural and Social Sciences Research, in the National Institute of Health, titled ‘Towards Higher Levels of Analysis: Progress and Promises in Research on Social and Cultural Dimensions of Health’, suggested integrating social science research into interdisciplinary, multilevel studies of health. It recommended a development of state-of-the-art social science method so as to measure data at various levels of social institutions.

If we agree that homeopathy is compatible as a mass therapy, how do we justify this phenomenon without deviating from homeopathic ideology? The Organon of Medicine not only provides examples of how the mass situations can affect the individuals – not just in the epidemic situation – but also in individual instances. In the aphorism 36, while discussing the simultaneous occurrence of dissimilar diseases, Hahnemann makes a mention of ‘… patient suffering from a severe chronic disease will not be infected by a moderate autumnal dysentery or other epidemic disease. The plague of the Levant, according to Larry does not break out where scurvy is prevalent, and persons suffering from eczema are not infected by it. Rachitis, Jenner alleges, prevents vaccinations from taking effect…’ Further, in aphorism 77, ‘… those diseases are inappropriately named chronic which persons incur who expose themselves continually to avoidable noxious influences …. These states of ill-health, which persons bring upon themselves disappear spontaneously, provided no chronic miasm lurks in the body, under an improved mode of living, and they can not be called chronic diseases’. These expressions underline the foresight and openness that Hahnemann had regarding aetiopathogenesis for homeopathic pathometrics.

He further distinguishes the characteristics of epidemic diseases vide aphorism 100, ‘…. A careful examination will show that every prevailing disease is in many respects a phenomenon of a unique character, differing vastly from all previous epidemics, in which certain names have falsely applied – with the exception of those epidemics resulting from a contagious principle, that always remains the same, such as small pox, measles, etc.’

In the aphorism 101, he states ‘… the carefully discerning physician can, however, from the examination of even the first and second patients, often arrive so nearly at a knowledge of the true state as to have in his mind a characteristic portrait of it, and even to succeed in finding a suitable, homoeopathically adapted remedy for it.’

In the aphorism 102, he states ‘… all those affected with the disease prevailing at a given time have certainly contracted it from the one and the same source and hence are suffering from the same disease …’

The above cited excerpts from Hahnemann’s writings iterate the compatibility that homeopathy has with the concept of community health. To take the argument further, we can assert that homeopathy not just takes cognisance of the individual or of the community in isolation, but an individual within the community and a community as a whole. The interrelationship of individual and community, and the outcomes of individual – community interactions have a strong bearing on the health of the individual and health of the community. Thus, the strength of homeopathic principles is the holistic community health, of which an individual is also a part. Another reason to assert that homeopathy and community health are mutually compatible is the approach to disease and illness is the holistic understanding that homeopathy has towards disease generation and health prevention, and the social model of health that is gaining wider acceptance in community health.

In the earlier model of public health practice, the working hypothesis was that diseases are caused as a result of exposure to noxious factors in the external environment. This is like the stimulus – response equation. Though this approach produced considerable successes in primary prevention, it does not satisfactorily address to the entire range of public health issues. Therefore, the emerging model of public health based on the social model suggests that in all its manifestations, disease is a reaction of the human organism to, and /or a failure to cope with, one or more unbalancing changes in its internal environment. These are caused by one or more unfavourable exchanges with the external environment and /or failures in the structural and functional design of the organism. Therefore, human illness is attributable to the dependence of organisms on a fundamentally hostile external environment and to unfortunate evolutionary legacies. This concept suggests that primary prevention is only a part of the whole and that there are different approaches to prevention, including interfering with disease mechanisms, and remedying human organisms’ design failures. This is much in tune with homeopathic approach that includes multilevel of parameters.

Therefore, the emerging model of public health, with a transdiciplinary approach stemming from the seamless fusion of medical humanities and clinical disciplines has veered to the homeopathic approach that was modeled more than two centuries back, and which was applied by homeopathic practitioners more in the individualized care settings than the community care context. It is now a challenge for the homeopathic community to leverage the principles and legacy of homeopathy to position homeopathy as a viable mainstream model for public health.

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