A Report of the First International Conference On

A report of the First International Conference on:

Global Health Futures: Creating integrated solutions to the epidemic of long-term disease

13th-15th November 2013, Marriott Hotel, Bengaluru, India

The recently Global Burden of Disease report published in the Lancet shows, while people are living longer, chronic illness is on the rise across the world. The College of Medicine and SOUKYA bought together experts from across the globe to tackle the issues around long-term illness and to formulate solutions (See Appendix 3 “The Bangalore Declaration”)

Key themes:

·  Modern conventional medicine cannot provide all the answers and sustainable integrated solutions are the only option. The current health systems across the world are unaffordable and can’t match the epidemic in long term disease, high tech solutions are not the answer for long-term disease.

·  Integrated solutions go beyond medicine. Whole-person care, patient information and guided self-care need to be taken more seriously in solutions of long term disease.

·  We need to focus on how health and wellbeing are produced and to considerculturally relevant healing traditions

·  Lifestyle approaches as treatment, not prevention. These low-tech, low cost interventions now have a compelling evidence base.

·  The need to explore preventative solutions that help people to manage the risksof developing long term conditions.

·  Importance of evidence-based medicine (EBM). The best medicine integrates clinical expertise and compassion with best available evidence.

·  The future of integrated care needs toinclude: evidence, education, regulation of practitioners and products, accreditation, changes in primary care models, updated treatment guidelines.

·  Asset-based community development offers a global opportunity for health improvement. Well established techniques enable communities to grow, flourish and gain more control over their environments.

·  Action towards health improvement must lead away from an almost total dependency on professional interventions and tools, toward community-building and citizen action. Health is not a product of health systems but of humanness interacting with itself, its environment and its economy.

·  Importance of embracing the digital revolution– Patient Passports where patient own their own record

·  Anything that makes for a more sustainable physical environment will simultaneously be promoting a healthier environment.

Speakers included: Sir John Oldham (National Clinical Lead forQuality and Productivity), HRH, The Prince of Wales (video message), His Excellency Dr Bhardway (Governor of Karnataka), Professor Dean Ornish, Dr Michael Dixon, Dr Isaac Mathai, Professor George Lewith, Professor David Peters, Professor Justin Wu andSir Jonathan Porrit. Closing ceremony attended by Archbishop Desmond Tutu and several Indian ministers and dignitaries.

Programme (See Conference Timetable - Appendix 3 )

Day 1: Morning session (Chair Sir Graeme Catto).

Welcome address: Integrated health and care: Why does it matter and why have a conference about it. Michael Dixon: Chair, College of Medicine, UK.

Key themes:

·  Modern conventional medicine cannot provide all the answers and integrated solutions are the only option for three reasons:

1.  Money – The current health systems across the world are unaffordable and can’t match the epidemic in long-term disease.

2.  Current solutions aren't working and we don’t have the right criteria for treating long-term conditions.

3.  Quality of life issues need to be taken into consideration. We need to create systems that provide care, including guided self-care, comfort and compassion.

Integrated medicine - A question of science and belief? Professor George Lewith, University of Southampton, UK.

Key themes:

·  We are all living longer with chronic co-morbidities and the present healthcare system is unaffordable.

·  Patients need to be encouraged to participate in guided self-care practices.

·  Complexities of evidence-based medicine (EBM). The best medicine integrates clinical expertise and compassion with best available evidence. Many paradoxes – the implicit assumption that all medicine provided by the NHS is evidence based is untrue – only about 35% of treatments used have a solid evidence-based. (citation?)

·  Patients are the motivators driving integrated care - science will always lag behind clinical demand.

·  We must consider the advance of scientism and learn to have some wisdom about how we manage the interface between basic science and clinical care with the patient as our partners and due respect for scientific advances.

Integrated approaches to long-term disease in the West - Australia as an example. Professor Kerryn Phelps.

Key themes:

·  Chronic diseases (as throughout the world) are responsible for a large portion of the disease burden in Australia. We need to think more about what individuals can do for themselves rather than what mainstream medicine can do for them.

·  Offered a vision of what integrated healthcare could look like in the future. Needs to include: evidence, education, regulation of practitioners and products, accreditation, changes in primary care models andupdated treatment guidelines.

·  CAM is increasingly popular in Australia (3.8% of population had consulted a therapist in last 2 weeks), but individuals have to pay themselves. Open minded patient-centred integration has not yet been achieved. Good examples of partial integration include SOLARIS, St Vincent’s Prostate Cancer Centre andthe Alfred Cancer Centre.

·  There is very little funding available for CAM research at present – cost effectiveness studies needed.

·  Professional education needs to include an integrated model.

·  Vision of future: Plans need to be whole of life, whole of person (building resilience) and whole of system.

Integrating approaches to long-term disease in the East.Prof Ranjit Chaudhury

Key themes:

·  Long- term health conditions are increasing in India.

·  Many traditional practices - Ayurveda, Unani, Yoga, Naturopathy, Homeopathy, Siddha, S - are recognised by the government.

·  There’s been a change in perception of integrated medicine in recent years owing to: limits of allopathic medicine, the professional middle classes turning to use of traditional medicine, international interest and the commercial potential of traditional medicine.

All government hospitals and primary healthcare centres in Delhi provide Ayurvedic and homeopathic services. Some major teaching hospitals also provide Ayurvedic, Unani and homeopathy – all provided by qualified doctors, but although tolerance is increasing there are few fully integrated services.

Dr Mathai welcome address:

Key themes:

·  Thanked – H.E. Dr Bhardwaj for his deep interest, commitment and understanding of integrative medicine, the sponsors, the media and his late father who taught him how to practice holism.

·  Gave overview of the background to the Global Holistic Summit.

Address by Dr Michael Dixon:

Key issues:

·  Overview of the key principles of the College of Medicine - Service, science and healing and how these will be areas that will be addressed in the content of the conference.

·  Integrated Medicine involves the best of both worlds gives personalised, patient-centred healthcare. Patients need medicine that includes them, which allows them to be involved in the co-production of better health and care and respects mind set and cultural beliefs of where they live.

·  Integrated solutions go beyond medicine. Patient information and self-care need to be taken more seriously in solutions of long-term disease. We need a “wellness” service not a “sickness” service.

·  The need to explore preventative solutions that help people to manage the risks of developing long-term conditions.

Video message from HRH the Prince of Wales:

Key messages:

·  Expressed sadness about not being able to attend the conference as he has greatly admired the many ancient traditions of healing in the East.

·  Gratified that integrated solutions to the epidemic of long-term disease are being explored.

·  Expressed gratitude to Dr Mathai and the SOUKYA foundation and the support of the Indian Government.

·  Importance to include the best of both worlds – conventional treatments and traditional complementary approaches.

·  Lifestyle, social (gave example of Hazel Stuteley’s work at Connected Communities) and environmental issues need to be attended to if the health system is to remain financially sustainable. Beauty is a vital ingredient of overall wellbeing – we are what we are surrounded by, as well as what we eat.

H.E. Dr Bhardwaj (Governor of Karnataka) released Dr Mathai’s book on women's holistic health to Professor Kerryn Phelps before giving the Inaugural Address:

Key issues:

·  Thanks and welcome.

·  India and UK have much in common. We need to work together to find integrated (mind, body, spirit and nature) solutions together for long-term conditions.

·  Emphasised the need for more research.

Dr Harry Brunjes (Vice-president, College of Medicine) gave a vote of thanks to all involved on behalf of the College of Medicine.

Day 1 – afternoon session (Chair - Dr Michael Dixon)

Asset- based community development offers a global opportunity for health improvement. Dr Brian Fisher MBE (HELP project) and Hazel Stuteley OBE (Connecting Communities,C2)

Key issues:

·  Health organisations (whether statutory or private) need to be working with the people we serve in the spirit of co-production.

·  We now have evidence how communities add social value. We need to move away from individual healthcare to community.

·  Asset-based (unlike deficit- based approach) working underpins the approach. Explore where resources/ assets are in people/communities and harness for the good of community.

·  C2 helps communities identify their own needs and aspirations and to take action to make aspirations happen and to improve the quality of their lives and the societies of which they are part.

·  HELP approach based very much on Hazel Stuetely’s 7 step approach model, Connected Communities (C2).

·  Principles - start with the issues that matter to people – they identify the agenda.

·  We now have evidence that community development does not only make statutory services more responsive, but also helps tackle health inequalities. It also saves money – social return (SROI: for every £1 invested get £4 back).

·  We need more research and improved health outcomes.

·  Introduced paper co-written by Samueli Institiute about opportunities for global community development (see Appendix 2).

Hazel Stuteley OBE(Connected Communities: Gave overview of Falmouth project (including video)-

“We thought we were doing up houses, we were doing up people's lives” quote from service user.

Integrated approaches for musculoskeletal approaches. Rosena Johnston (Chartered physiotherapist, faculty member College of Medicine) Simon Fielding OBE (Osteopath, trustee College of Medicine).

The workshop gave an overview of an integrated approach to tackling back pain and a practical demonstration of exercises that can facilitate better spinal health.

Key issues:

·  Psychosocial factors play an important role. Risk factors include heavy manual work and poor posture associated with sedentary occupation and obesity.

·  Single mono therapies don't work (analgesics etc). An integrated multi-disc approach which includes exercise, manual therapy, analgesic and self-management provide the best outcome. There is good evidence for behavioural and cognitive interventions such as CBT.

·  The Sarah Key method was demonstrated - a five stage approach to back pain.

AYUSH - An introduction to Ayurvedic and other Eastern traditions and techniques.

Session Chair - Dr R K Manchanda.

The role of Ayurveda in contemporary medical milieu. Professor Gangadharan, Medical Director of the Institute of Ayurveda and Integrative medicine, Bangalore.

Key issues:

·  Overview of Ayurveda (literal translation -- the 'Science of Life', - history, origin (1500-1000 BC) discussion and the limitations of science. Traditional approached need a different framework of understanding.

·  Discussed work of the I-AIM Health Centre, Bangalore.

Panchakosha - Integrated approach of Yoga therapy. Dr Nagendra H R,

Key issues:

·  An overview of the Pancakosha model (five layered existence of human beings) was given for functional integration of different systems of healthcare.

·  Exploration of an integrated approach of yoga therapy.

The role of Unani in integrated medicine today. Dr Quamri Dept of General Medicine, Bangalore.

Key issues:

·  The presentation gave an overview of the practical application of Unani – a Graeco-Arabic system of medicine which is part of the AYUSH system of medicine.

·  Unani includes a number of modalities including pharmaco therapy (plants - mostly, some minerals and animals), regimental therapy (exercises, massage, cupping, leeches, diaphoresis, bathing and irrigation) dieto therapy and surgery.

·  Unani medicine focuses on the concept of the four humours: phlegm, blood, yellow bile and black bile.

Global awareness and usage of Siddha Medicines. Dr Kumaravel A

Key issues:

·  Siddha medicine is one of the most ancient medical systems in the world. It is thought to have originated over 2500 years ago in Southern India.

·  Goals are to attain perfection. The philosophy states that all objects (including human body, plants, minerals, animals etc.) are composed of five basic elements viz, Earth, Water, Fire, Air and Sky.

·  It has a unique system of diagnosis.

Scope for Integration of Naturopathy in the epidemic of long term diseases. Dr Babu Joseph

Key issues:

·  Overview of naturopathy including fasting, massage, water and mud therapy, yoga and meditation.

·  Characteristics of naturopathy - drugless, non-invasive, rational and evidence-based. Chief principle - human body has remarkable recuperative powers when left alone. Fasting - abstinence of food except water (sometimes coconut or honey water for period of time).

Integrated Medicine and Homeopathy - the Royal London Hospital for Integrated Medicine (RLHIM) Model. Dr Peter Fisher

Key issues:

·  The RHLIM is part of University College London/NHS:their services are commissioned by the NHS.

·  Clinical services are based around diagnoses or groups of patients rather than therapies. Services include: Allergy, Children’s, Chronic Fatigue Syndrome, Chronic Pain, Musculoskeletal Medicine, Insomnia, Rheumatology, Skin, Stress and Mood disorder, Women’s and Weight Loss. The services offer homeopathy and a range of other therapies supported by a comprehensive pharmacy service.

·  Context - multi-morbidity is very common which challenges the whole way we think of medicine. Adverse drug events are escalating and poly-pharmacy is a key problem area.

·  Research in homeopathy shown to reduce medication (Rossignol et al., Rossi et al. Sinha et al..)

·  Collecting PROMS (patient related outcome measures) on all patients. Qualitative study is underway exploring what enables/what prevents self-care.

·  A recent survey showed a 98% satisfaction ratio (NHS choices).