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Can naturopathy provide answers to the escalating health care costs in India?

There are substantial areas of overlap between naturopathy and public health, which include a focus on health rather than disease, a preventive approach, and an emphasis on health promotion and health education. Public health can look to naturopathy for answers to the emergence of chronic disease through natural therapies, many of which can take the role of primordial and primary prevention of several diseases. Some selected naturopathic therapies include nutrition, hydrotherapy, fasting therapy, yoga, behavioral therapy, and health promotion. We must reorient our focus on prevention and wellness to make a true impact on escalating health care costs. With the National Health Policy in India emphasizing the need for integrating the Indian Systems of Medicines with modern medicine, now is the right time for naturopathy and public health to come together to provide a holistic health care system.


What is naturopathy?
Naturopathy is a drugless, noninvasive, rational, and evidencebased system of medicine that imparts natural therapies, based on the theory of vitality, toxemia, the self-healing capacity of the human body, and the principles of healthy living. This approach to health care emphasizes education, self-responsibility and therapies to support and stimulate an individual's self-healing capacity. The principles of naturopathy were first used by the Hippocratic School of Medicine in approximately 400 BC. The Greek philosopher Hippocrates believed in viewing the whole person in regards to finding a cause of disease, and in using the laws of nature to induce a cure. 1

Public health and naturopathy-intersecting paradigms
Public Health (PH) is defined as ''the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals." 2 The philosophical approaches of naturopathy include disease prevention, encouragement of the body's inherent healing abilities, natural therapies, personal responsibility for one's health, and education of patients regarding health-promoting lifestyles. 1 Thus there are substantial areas of overlap between naturopathy and PH such as a focus on health rather than disease; a preventive approach; and an emphasis on health promotion, health education, and patient empowerment.

Naturopathy and chronic diseases
Chronic lifestyle diseases are now the leading cause of disease burden and morbidity globally which are attributable to modifiable health behaviors such as tobacco use, poor diet, and physical inactivity. 3,4 Public Health can look to naturopathy for answers to some of these challenges through different natural therapies, many of which can take a role in primordial and primary prevention of several diseases. By contrast, PH can identify mechanisms to effectively deliver principles of naturopathy such as improved public access to naturopathic physicians in community clinics, increasing formal collaboration between naturopathic and other health professionals, or increasing the number of trained integrative medicine providers.

Nutrition
Food is regarded as medicine in naturopathy. Good nutrition is the foundation of naturopathic practice for health promotion and disease prevention. Foods are considered best in their natural form, when obtained locally and eaten seasonally.

Hydrotherapy
Hydrotherapy is the external or internal application of water in any of its forms such as ice, water, steam. Hydrotherapy uses temperature effects of water, as in hot and cold baths, steam baths, compresses and fomentation, saunas, wraps, and immersion baths. Other modalities include spinal bath, sponge bath, hip bath, sitz bath, enema, and colon hydrotherapy.

Fasting therapy
Fasting is primarily the act of willingly abstaining from some or all food, drink, or both, for a period of time during which the body excretes huge amounts of accumulated wastes. Methods of fasting include water, fruit juices, lime juice, or raw vegetable juices.

Yoga
Yoga is a Hindu spiritual and ascetic discipline which includes breath control (pranayama), simple meditation, and the adoption of specific bodily postures (asanas). The aim of practicing pranayama is to stimulate, regulate, and harmonize vital energy of the body. Asana means holding the body in a particular posture to bring stability to the body and mind.

Behavioral therapy
Naturopathy focuses on assisting clients in identifying and modifying unwanted behaviors through basic counseling, lifestyle modification, hypnotherapy, meditation, and stress management. To achieve this, it is essential to spend quality time listening to the patient so as to understand the way they live and to strengthen the physicianepatient relationship. It has important implications in behavioral modifications, which is the mainstay of treatment of chronic diseases.

Health promotion
Health promotion is deep-seated in the practice of naturopathy, both philosophically and in the delivery of health care. Studies of naturopathic practice have shown that health promotion counseling on diet, physical activity, and stress management is incorporated into almost every clinical encounter (80e100%) and is reinforced in subsequent patient visits. 5,6 However, conventional care has low rates of health promotion practice (<35e40%). 7 Thus, at the individual and community levels, health promotion could benefit from closer collaboration with naturopathy.

Trends in the use of naturopathy worldwide
Patients are increasingly seeking naturopathic therapies for many reasons, the most common of which is patients wanting to use all possible modalities of care. Other important reasons include a holistic approach that addresses the root of the problem, more time and attention from the doctor, concern about the adverse effects of drugs, more control over the treatment, and having not been helped by conventional care. 8 Nearly 80% of the population in developing countries depend on traditional systems of medicine as a source of primary healthcare. 9 Fig. 1. Naturopathy as a tool to combat rising health care costs in India.

Policy environment for naturopathy in India
The AlmaeAta declaration recognized the value of traditional systems of medicine and advocated the integration of safe and effective traditional medicine practices into primary health care. 10 The World Health Organization has urged its member states to integrate complementary and alternative medicine (CAM) into their national health care systems. The National Policy on Indian Systems of Medicine and Homoeopathy 2002 emphasized the need for a meaningful phased integration of the Indian Systems of Medicines with modern medicine. The government of India also has iterated that the Indian Systems of Medicine offers a wide range of preventive, promotive, and curative treatments that are costeffective and efficacious. 11 There is a need to end the long neglect of these systems in our health care delivery mechanism.

Cost-effectiveness
Evidence suggests that a nation could save millions in health care costs and provide better quality of care without compromising patient outcomes if alternative medicine is widely practiced (Fig. 1). 12,13 Comprehensive systematic reviews have identified emerging evidence of the cost-effectiveness of various alternative therapies, compared to the usual care. 14,15

Need for a policy
Issues such as safety, efficacy, and quality need to be addressed to extend naturopathic care. These can be best tackled within the framework of a national policy. The policy should focus on the registration and licensing of providers, standards of training, safety monitoring of drugs and therapies, and the development of technical guidelines and standards of care. Clinical research into the use of naturopathic practices for treating common illnesses should be encouraged.

Conclusion
There is limited evidence for the efficacy of practices of naturopathy, and limited evidence to prove its ineffectiveness. 16 This may be because of the limited number of practitioners with skills and intellect to conduct research and generate strong evidence in favor of the practice. The lack of compelling data on the safety and efficacy of naturopathic approaches pose opportunities for research. We must reorient our focus on prevention and wellness to make a true impact on escalating health care costs. The discipline of naturopathy medicine ought to take the lead in this approach towards effective health care delivery.