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rodrigo luruena

on 4 January 2013

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Objectives Motivation for Research Naturopathic Care Naturopathic Care in Switzerland Conclusions

Master of Environmental Science (MUSE)
Master's Thesis: Analysis of Naturopathic Care from a Sustainable Perspective Definition by
Rodrigo Lurueña
December 18, 2012 The Sustainability of Naturopathic Care Case Study Objectives OUTLINE: “We have done to our bodies what we have done to the soil -used heroic measures to conquer organisms while destroying the natural ecology that has existed in equilibrium for generations” (Kaur, 1999, pg. 93). “Human beings are at the centre of concerns for sustainable development. They are entitled to a healthy and productive life in harmony with nature”(United Nations, 1992). Research Questions Hypotheses Methodology Define Naturopathic Care

Analyse Naturopathic Care in Switzerland

Evaluate the Social, Economic and Environmental Benefits of Naturopathic Care 1. What are the origins of naturopathic care and how it is defined?

2. What is the relevance of naturopathic care in Switzerland?

3. Should the inclusion of naturopathic care into Swiss compulsory basic health insurance be only based on its efficacy and economic efficiency?

4. What are the social, economic, and environmental benefits of naturopathic care?

5. Can naturopathic care make people’s lifestyles more sustainable? Swiss basic health insurance (2012): phytotherapy, Chinese medicine, homeopathy, anthroposophic medicine, and neural therapy 1. Naturopathic care provides important economic, social and environmental benefits.

2. Naturopathic care contributes to the creation of sustainable lifestyles. 1. Literature Review of Naturopathic Care:
Electronic Databases
Medical Journals
Swiss bureau of statistics
Swiss Department of Public Health
Special reports made by international organizations like the WHO

2. Empirical Case Study
Survey (50 questions)
Lifestyle comparison
Group 1 (naturopathy students, ECN)
Group 2 (general public) Practice of medicine with infinite natural healing agents.

1. Restore patients’ health through the beneficent agency of Nature’s forces.

2. Restore the human consciousness about its place in “the natural order of the cosmos and to re-establish the union of man's body, brain, heart and all bodily functions—with nature" (Whorton, 2003, pg.23). Integrative system that uses centuries-old natural therapies with current advances in the understanding of health and human systems.

1. Preventing disease
2. Supporting the body’s self healing abilities
3. Providing holistic treatment
4. Encouraging responsibility for one’s health
5. Educating patients for the construction of healthy lifestyles History Philosophy Treatments Challenges Industrial Revolution
1750-1850 Lifestyle and Nutritional Changes Life Reform Movement (GERMANY) Benedict Lust
(USA) Fundamental principles:

1. Do no harm
2. The healing power of nature
3. Identify and treat the causes
4. Doctor as teacher of healthy lifestyles
5. Treat the whole person
6. Prevention •Utilization of all methods of clinical and laboratory diagnostic testing including diagnostic radiology and other imaging techniques

•Nutritional medicine, dietetics and therapeutic fasting

•Medicines of mineral, animal and botanical origin

•Hygiene and public health measures

•Naturopathic physical medicine including naturopathic manipulative therapies

•The use of water, heat, cold, light, electricity, air, earth, electromagnetic and mechanical devices, ultrasound, and therapeutic exercise

•Homeopathy and acupuncture

•Psychotherapy and counseling

•Minor surgery and naturopathic obstetrics (natural childbirth) Stout legal framework or national policy

More research

New research methodology

Accessibility and proper use 50% of the Swiss population has used CAM at least once
2002= 15% of the pop. used CAM
2007= 23% of the pop. used CAM
Homeopathy and Acupuncture
Highly educated, women, 25-64 years old
54% of pop. has a CAM policy insurance
World's highest number of CAM practitioners per capita (in total 23'000) Use Regulation and Education There are two labels (ASCA and RME)

Access to the Swiss National Fund (FNS)

University of Bern and Zurich have an institute for the study of CAM

University of Bern counts with courses in homeopathy, neural therapy, traditional Chinese medicine, phytotherapy, anthroposophic medicine, hydrotherapy, and bio-resonance

Swiss Medical Association ( Homeopathy, Chinese medicine, acupuncture, anthroposophic medicine, or neural therapy)

Private Schools Each canton has its own regulation for CAM

Lack of a recognized federal diploma in alternative medicine. However, the Federal Bureau of Education and Technology is studying the possibility of creating one

Weak regulation of health professionals without a university diploma Pros: Cons: Basic Health Care Insurance 1999: First introduction of 5 CAMs (Homeopathy, Chinese medicine, Anthroposophic medicine, Neural therapy, Phytotherapy)
6-year trial period
Efficacy & Economic Efficiency
PEK: inconclusive results
2005: Withdrawal of 5 CAMs 2012: Reintroduction of 5 CAMs
6-year trial period
HTA: Efficacy & Economic Efficiency Sustainability Social Naturopathic Care:

Natural and non invasive treatments and products

Very low filled complains against naturopathic care Conventional Care:

Iatrogenic Illnesses


Analgesics, sedatives, sleeping pills, and psycho-stimulants (among the 10 most sold drugs)

One out of two individuals over15 years old consume at least one type of medicament per week.

Medicine consumption increased 10% from 1992 and 2007 Safer & Better Naturopathic Care:

Holistic and patient-centered approach

Emphasis on health promotion and disease prevention

Focus on patient education WHO :

Chronic illness and disease requires a shift from conventional care

Focus on prevention and changing people’s behavior and habits Environment and Health Action Plan

Sustainable Development Strategy Plan
(2012-2015) Economic Conventional care increasing health care costs:

Increase of chronic diseases
24.9% of total health expenditure is spent in medicines
CH: 1.41% of GDP
CH: highest retail price
Annual per capita spending on pharmaceuticals has double from 1995-2006 ($418) Cheaper and Cost-Effective Evidence of Naturopathic Care Cost-Effectiveness:

Cost-Effectiveness 53-63% higher for osteoarthritis, back pain, neuroses, asthma, acid peptic disorders, headache, obesity, and peripheral facial paralysis (WHO, 2002)

Savings between $367 and $1,420 for back pain, fibromyalgia syndrome, and menopause (Lind, Lafferty, Tyree, & Fiehr, 2010)

Homeopathic medications are about 75-80% cheaper than conventional care drugs (Chaufferin, 2000)

3.7-73% reductions in treatment costs, postoperative complications and mortality, and hospital related costs, due to the use of NHP (Kennedy, Hart, & Seely, 2009) Counter arguments:

Additional cost
Acupuncture (Wonderling, 2004)
N-3 PUFA ($1030) (Franzosi, et al., 2001)
Younger, female and healthier patients (Busato, Eichenberger, & Künzi, 2006)
Many naturopathic modalities and products still to evaluate.
Lack of proper research methodologies limits the significance of the available data Environment Naturopathic Care:

Products with a low environmental impact Conventional Care:

Products with high environmental impact ( i.e. antibiotics, analgesics, hormones, and cardiovascular drugs)

Endocrine disruptors in rivers (Green Facts, 2002)

Hormones in ground waters (Morel, 2008)

Microbiological changes and antibiotic resistance (FNSFN, 2006) Lower Environmental Impact Direct Impacts Naturopathic Care:

Behavior change and food consumption is essential

Average consultation time 40 minutes vs. 15 minu (Cherkin, et al., 2002) Conventional Care:

Dietary and physical activity counseling (30% to 45%) (Stanford Univ., 2004) Indirect Impacts 20-30% of the total environmental impacts (Tukker & Jansen, 2006).

The biggest contributor to global warming (Wolf, et al., 2011).

Life Cycle Analysis (Tobler, Visschers, & Siegrist, 2011) More research is needed... Measuring the benefits of naturopathic care from a sustainable perspective

Contribute to the current debate

Highlight the importance of including the environmental dimension in current and future research Methodology Survey in the city of Geneva

Lifestyle and Ecological Footprint of 2 groups of people

Ecological Footprint Calculator

Software SPSS Statistics

G1: Naturopathy Students (High naturopathic values and important use of naturopathic care)

G2: General public

Sample size: 30 individuals/ group

Same demographic characteristics in both groups Results Higher vegetable and consumption in G1
G1: 40% in 3 vegetables/day
G2: 40% 1 vegetable/day

Higher fruit consumption in G1
G1: 60% 3-7 fruits/day
G2: 53% 1 fruit/day

Lower consumption of meat in G1
G1: 43% vegetarian or eat meat once every two weeks
G2: 10% vegetarian or eat meat once every two weeks

Lower consumption of eggs and dairy in G1
G1: 26% eat them often or very often
G2: 76% eat them often or very often

Lower tobacco use in G1
G1: 63%% never smokes
G2: 53% never smokes

Lower alcohol consumption in G1
G1:56% rarely or never drinks
G2: 16%% rarely or never drinks

Higher number of hours exercising in G1
G1: 3h
G2: 2.4h
Better results in self-health assessment in G2
G1:53% good health
G2: 72% good health Healthy Lifestyles Efficacy and Economic Efficiency G1: 73% naturopathic consultations
G2: 35% naturopathic consultations Type of consultations Outcome Satisfaction Health Care Spending G1: 22'608 CHF
G2: 33'298 CHF Eco-Friendly Lifestyles Ecological Footprint & Earth's Productive Area Needed G1: 2.42 Planets
5.12 hectares
G2: 3.21 Planets
6.75 hectares Lower consumption of meat, eggs, and dairy in G1 Discussion NC better for chronic diseases and promoting behavioral changes

Healthier habits
Higher health standards
More critical regard
Better health outcomes from NC consultations
High satisfaction degree Social Higher number of routine visits
Higher consumption of dietary supplements
Higher food spending

Higher focus on health promotion and prevention.

Investments in health rather than disease

Lower health care expenses (10’690 CHF) Economic Environmental NC promotes a sustainable lifestyle

Lower ecological footprint in G1

Senior students have a lower ecological footprint in G1

NC influences G1 lifestyles (90% of individuals) No generalizations can be made G1: 50% (diet 3/4 fresh unpackaged products)
G2: 26% (diet 3/4 fresh unpackaged products)
G1: 50% (diet 3/4 regional products)
G2: 23% (diet 3/4 regional products)
G1: 60% (buys organic products very often)
G2: 7% (buys organic products very often) G1: 57% (consume much less than average)
G2: 27% (consume much less than average) G1: 57%
G2: 17% G1: 90%
G2: 33% Naturopathy can can create sustainable lifestyles More sustainable lifestyles in G1 Lower consumption of goods in G1 Much higher consumption of fresh, unpackaged, regional, and organic products in G1 NC reduces health care costs 1. What are the origins of naturopathic care and how it is defined?

Industrial revolution
Life-reform movement
Benedict Lust
Practice of medicine

2. What is the relevance of naturopathic care in Switzerland?

Popularity of NC
Increasing demand
Young females
Room for improvement (education and regulation)

3.Should the inclusion of naturopathic care into Swiss compulsory basic health insurance be only based on its efficacy and economic efficiency?

Need of integrating a sustainable perspective into health care

4. What are the social, economic, and environmental benefits of naturopathic care?

Healthier lifestyles
Lower health care costs
Promotion of sustainable lifestyles

5. Can naturopathic care make people’s lifestyles more sustainable?

NC encourages behavioral changes
More natural and durable lifestyles Research Questions No generalizations Hypotheses 1. Naturopathic care provides important economic, social and environmental benefits.

Few research and low quality of the available data

2. Naturopathic care contributes to the creation of sustainable lifestyles.

Small sample size Recommendations for Future Research Need of further research with a three-dimensional approach

Need of new methodology

Study cases with a larger sample size 1901 THANK YOU! More research is needed...
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