Development and regulation of traditional Chinese medicine practitioners in Hong Kong

Abstract

Professor Sian Griffiths and Vincent Chung from the University of Hong Kong offer an insight into the history, and future, of Chinese medicine In response to the increasing popularity of traditional, complementary and alternative medicine (TCAM) worldwide,1 the World Health Organization (WHO) has launched a Traditional Medicine Strategy 2002-52 emphasizing the goal of facilitating the development of TCAM national policies among member states. In 2005, the WHO conducted a global survey on TCAM development and found that 45 of 141 (32%) responding member states have established national policies on TCAM, while 51 (56%) were contemplating such development.3 One of the major elements of TCAM policy is the regulation of practitioners and this issue is high on the policy agenda of many developed countries, including the UK,4 Australia,5 Canada6 and the US.7 In the West, the profile of TCAM rose as part of its 'renaissance' in the late 1 990s, spurred by dissatisfaction with conventional western medicine (WM) as well as a growing exploration of global ideas. However, in other parts of the world, both history and culture determined a different course. In Hong Kong, the origins of TCAM development can be dated back to its creation in the mid- 19th century. Hong Kong was a British colony for over 100 years until the handover of its sovereignty to China in 1997. WM practice was introduced to Hong Kong and southern China by missionaries at the end of the 19th century8 but although it was the formal healthcare system, traditional Chinese medicine (TCM) remained the medical care of choice for most of the population due to accessibility, affordability and cultural appropriateness. Despite TCM's wide usage, the British colonial government adopted a laissez-faire policy towards it TCM was treated as an indigenous custom and was monitored by the Secretary for Home Affairs instead of the Secretary for Health. The government's sanction of TCM practice started in 1894, when the health officials deemed TCM to be 'incompetent' in managing the plague epidemic.8 Popularity of TCM further declined during the Japanese occupation in World War II, when many Chinese were repatriated over the border to mainland China. In the post-war period TCM practice continued only in small private settings.8 Thus, TCM was unregulated for most of the 20th century. The situation in colonial Hong Kong contrasts starkly with mainland China's policy in promoting the coexistence and integration of TCM and WM since the 1950s.9 Today, the WHO recognizes China to be one of the first healthcare systems in the world to adopt full integration of TCAM and WM at all levels of care.2 In China's latest healthcare reform proposal, TCM's potential role in tackling the burgeoning problem of chronic non-communicable disease within its ageing population has been highlighted.10 Under the influence of Beijing's long-established national TCM policy, Hong Kong's reunification with China in 1997 signified the end of stagnation in TCM development.11 The impetus for change had become apparent in legislative change in the last decade of the colonial period.12 This legislation triggered the colonial government to carry out preparatory work for TCM development. With the handover back to China on 1 July 1997, the first Chief Executive of the Hong Kong Special Administrative Region (SAR) announced the government's initiatives in developing TCM, and a consultative document on the issue was published in the following month. TCM's role in the Hong Kong healthcare system was officially recognized for the first time after 1 00 years of marginalization. Similar top-down commitments have been re-emphasized in the Chief Executive's policy addresses of 2001 and 2005, and also in the 2007 election manifesto of the current Chief Executive of the SAR. The focus of development in the last decade of TCM development has been the regulation and professionalization of TCM practitioners (TCMP). …