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HP and
Health promotion and complementary
complementary medicine: the medicine
extent and future of professional
281
collaboration and integration
Received May 2005
Faith Hill Accepted September 2005
Division of Medical Education, School of Medicine, University of Southampton,
Southampton, UK

Abstract
Purpose – To explore the professional interface between health promotion (HP) and complementary
and alternative medicine.
Design/methodology/approach – A discussion paper, based on qualitative research involving
in-depth interviews with 52 participants from either side of the interface.
Findings – The current interface is predominantly limited to information exchange but there are
innovative examples of partnership working on both sides. Key determinants of future collaboration
include: the changing nature of both HP and complementary medicine; the place of science and
biomedicine; the role of the individual; and perceptions of health, holism and spirituality. There is a
perceived need for professional training and development in the area.
Research limitations/implications – The discussion presented is based on a small scale,
qualitative study and further research is needed to explore the issues raised.
Practical implications – One-third of the public in the UK now use complementary medicine and
this paper explores ways in which HP may respond to this development.
Originality/value – The paper makes an important contribution to an area where there has so far
been little professional debate.
Keywords Health, Alternative medicine, Integration, Development
Paper type Conceptual paper

Introduction
This paper explores the professional interface between health promotion (HP) and
complementary and alternative medicine (CAM). It examines the nature and extent of
current collaboration and integration between the two sides of the interface and
identifies key determinants of future development. The paper also discusses how
collaboration and integration might be managed and what training needs professionals
may have in relation to the HP/CAM interface.
Collaboration between different professional groups became increasingly important
for HP during the 1990s (Scriven, 1998; Roe et al., 1999). Saving Lives: Our Healthier
Nation (Department of Health, 1999) emphasised the government’s commitment to
an integrated approach to HP, with all sectors of society contributing towards a
“partnership” for health. It has been suggested that complementary medicine is Health Education
Vol. 106 No. 4, 2006
an ideal partner for HP (Correa, 1999; Whitehead, 1999). pp. 281-293
Complementary medicine has increasing popularity and acceptance in the UK and q Emerald Group Publishing Limited
0965-4283
surveys show that approximately one-third of the population in the UK (Ernst, 1996; DOI 10.1108/09654280610673463
HE Thomas et al., 2001), and slightly more in the USA (Wootton and Sparber, 2001), have
106,4 used complementary medicine. The medical profession still questions many of the
claims of complementary medicine but CAM therapies are increasingly practised in
conventional medical setting (Vickers, 2000). A House of Lords (2000) Select Committee
Report concluded that for some CAM therapies there was sufficient evidence to
recommend use within mainstream healthcare.
282 The discussion in this paper draws upon the findings from a research study that
explored professional perceptions of the HP/CAM interface in developed countries
(Hill, 2003a). The research methods used for the study were exploratory and used a
qualitative fieldwork approach based on the principles and practices of contemporary
ethnography (Miller and Dingwell, 1997; Gray, 2003). Data was collected through
in-depth interviews with 52 key informants from a range of relevant HP and
complementary medicine settings, primarily in the UK but also in the USA and Eastern
Europe. The aim of the fieldwork was to provide authentic insights into professional
perceptions through an in-depth approach to interviewing whereby the meanings and
interpretations of participants in relation to the HP/CAM interface were explored. The
interviews were conducted in such as way as to enable meanings to emerge through
discussion and were not designed to collect pre-determined, fixed perceptions.
Most participants in this study were “key informants” chosen because their position
and/or publications indicated that they might have useful insights into the research
issues. These key informants were selected on the basis of theoretical sampling, using
both deductive and inductive methods. That is, some participants were selected on the
basis of prior theory and insights from previous data and some were chosen as a result
of emerging data. This combined approach to theoretical sampling is consistent with
the concept of adaptive theory which argues for a creative interplay between prior,
extant theory and emergent data (Layder, 1998)
Interviews were carried out with health promoters from education, the health
services and the voluntary sector and complementary therapists working in different
settings and from a range of therapies. Although the research was UK focussed, it was
looking at the interface between HP and complementary medicine as it is practised in
developed nations. The USA appeared from the literature to be at the forefront of many
initiatives in the use of complementary therapies and 12 key informants were,
therefore, interviewed in the USA. A focus group interview was also conducted in
Budapest. This focus group was composed of key professionals in the development of
HP within their own countries.
The interview data was analysed following the principles of grounded analysis
described in Ball (1990), Bartlett and Payne (1997) and Layder (1998). A full process of
open coding was undertaken prior to categorisation and identification of emerging
themes. Constant comparison of codes and categories was used to guard against bias
and to compare emerging theory with the original data. A selection of transcripts was
independently coded to help ensure validity and an audit trail was compiled to provide
evidence of the processes undertaken.
The terms collaboration and integration are used in the paper to refer to professional
activities that cross HP/CAM boundaries. The terms overlap to some extent and cover a
wide spectrum from separate identity through to complete merger and this will be
discussed in the following sections. The term HP covers the promotion of positive health
and the prevention of illness, through health education and public policy initiatives.
There are, of course, many different models of HP but for the purpose of this paper they HP and
are taken together except where explicitly stated. The significance of the different
models of HP in relation to CAM is discussed elsewhere (Hill, 2003b). Similarly, the term
complementary
complementary and alternative medicine is used to describe a wide range of medical medicine
systems, diverse therapeutic practices and alternative healthcare systems that fall
outside the boundaries of conventional biomedicine. It is beyond the scope of this paper
to distinguish between the different CAM systems but it is acknowledged that some 283
forms of CAM are more readily acceptable to health promoters.

Levels of HP/CAM integration

The theory on collaboration and integration is very tentative and a number of different
models have been developed to facilitate understanding of the stages and processes
involved (Delaney, 1996; Leathard, 1997; Scriven, 1998). The calibration model depicts
the way in which integration can develop through a series of five steps from separate
identity through to eventual merger (Audit Commission, 1993, reproduced in Leathard,
1997). The model closely fits the levels of HP/CAM integration that were identified in
the study and will be used to discuss each level in turn.
Level 1 of the calibration model is defined as separate entities. The study found
evidence that most HP functions at level 1 in relation to complementary medicine and
that most health promoters carry out their professional duties with little or no reference
to complementary medicine. Complementary medicine does not feature to any great
extent in HP journals or form a significant part of the training of most HP specialists.
National organisations concerned with HP do not seek to involve complementary
medicine in identifying or working towards national targets. Indeed, the Health
Development Agency, and now its successor the National Institute for Health and
Clinical Excellence, have little involvement with complementary medicine.
At level 1, individual health promoters who attempt to incorporate aspects of
complementary medicine into their practice find their activities marginalised or
curtailed by management. Restrictions may be imposed because complementary
medicine is seen as irrelevant to national or local targets. One interviewee reported:
The old health promotion units used to have a lot of freedom but we are contracted very
tightly now. If it falls outside the national health promotion agendas it is too way out.
Further problems include the pressure of other initiatives and the challenge of
convincing senior management, particularly directors of public health. Another health
promoter summed this up when discussing her director of public health:
He said that we are not endorsing complementary therapies – full stop. We do not fund them.
And we do not encourage the trusts to use them and if they do we are not funding it. He said,
we must be a role model . . . we must never leave ourselves open to people pointing a finger.
Health promoters working in a clinical setting may find their activities blocked by
biomedical doctors and senior managers. The evidence base of complementary medicine
is constantly questioned at this level of integration. As one interviewee commented:
It is all so governed by medicine. It is amazing when you think about it . . . it is amazing that
the doctors have the yea or nay on whether it occurs or not. I think it should really be the client.
The complementary medicine side of the interface also tends to function at the first
level of integration. Complementary therapists may consider themselves to be involved
HE in promoting health and even identify some of their activities as HP. However, it was
106,4 evident from the study that they are largely unaware of professional HP and rarely
interface directly with health promoters. They may not see themselves as part of an
integrated healthcare system and often work in isolation. Where they do work
alongside other healthcare professionals, their roles are quite separate from
professional health promoters.
284 Level 2 represents the first stage of integration and involves active collaboration by
keen members on either side. Although most HP activity appears to function at level 1,
this study also found numerous examples of the HP/CAM interface functioning at level
2. For example, many health promoters are keen to offer information on
complementary medicine, if only because they are concerned about possible harm
and wish to challenge misconceptions. As one said:
It is important that people are able to make judgements about alternatives to the medical
model and biomedicine . . . ranging from consumerism, what is available, through to the
ability to look critically at effectiveness . . . It is important to make information available to
people so they can make choices. That would seem to be the essence of empowered health
promotion.
HP students also expressed a need for information on complementary medicine and
their training courses were increasingly offering taster sessions in response to this
need. For example, a lecturer reporting a session with an aromatherapist:
She comes in and she transforms the classroom into something else . . . She brings flowers
and lights candles and has a burner with wonderful lavender oil and . . . the students cannot
quite believe it.
At level 2, complementary therapists are aware of specialist HP and may seek to be
included in directories, or other HP information processes. However, the HP they offer
may still use traditional health education techniques and they are relatively unaware of
recent developments in professional HP. Many of the therapists interviewed for the
study would fall within this category.
Level 3 moves from information exchange to positive action. When this level of
integration becomes established, individual health promoters interested in the interface
increasingly become viewed as innovators, rather than mavericks. They become
involved with complementary medicine in a number of ways. For example, they may
facilitate the provision of complementary therapies for their client groups. The study
found examples ranging from health promoters organising holistic baby-massage
classes, through to the provision of Tai-chi for the elderly infirm.
Health promoters at level 3 are also keen to learn about the principles and practice of
complementary medicine and look for more in-depth training in this area. A number of
examples were given of health promoters seeking training in one or more
complementary therapy. There was also evidence that some academic health
promoters were keen to research the effectiveness and acceptability of complementary
medicine. In theory, at this level, complementary medicine could become an important
issue within academic HP journals. Professional HP bodies could also become actively
involved at the interface – although there is no evidence of this as yet.
In theory, complementary medicine at this level of integration is actively involved
with HP. Therapists are involved in providing a wide range of services for HP clients.
They contribute to the teaching of students on specialist HP courses and take part in
research programmes. However, they rarely change their own practice of HP and so the HP and
integration may be seen as one-sided. Complementary medicine has moved into HP but complementary
has changed little in itself. It may also be dependent on the initiative and leadership
coming from HP. However, the study identified one interesting example of medicine
complementary medicine initiating integration of HP. A major text on complementary
medicine included significant discussion of HP issues (Woodham and Peters, 1997).
There are even fewer examples of level 4 integration in practice. In theory, the 285
integration becomes more of an equal partnership. Health promoters set up working
groups with complementary therapists and plan activities together. Health promoters
may train in complementary techniques and offer these directly to their clients.
Complementary therapists may undertake training in HP and work in ways more
readily acceptable to specialist health promoters. Together, they may deliver HP
programmes, such as in hospital outreach programmes observed in the USA.
Finally, at level 5, the distinction between health promoter and complementary
therapist is no longer viable. Integration is complete to the point where it can be
claimed that both sides of the interface have merged to form a new paradigm of health
care. Examples of this new paradigm in action are hard to find. The research did
identify HP programmes in Chicago that offered such a melting-pot of complementary
medicine and HP that it would be difficult to separate out the two disciplines. Several
interviewees believed that merging identities with complementary medicine was the
way forward for HP. Indeed, some believed it was the only way forward for HP:
The world is moving on . . . there’s this stuff . . . (CAM) . . . and that’s what real people are into.
Sooner or later somebody’s going to get the idea that holistic medicine and health promotion
need to converge.
To summarise, it would seem that at this point in time the HP/CAM interface is mostly
functioning as two separate entities, consistent with Audit Commission Level One
(Leathard, 1997). There is also considerable evidence of increasing information
exchange and general collaboration, consistent with level 2 integration. There is some
positive action and involvement at both levels 3 and 4, but this is very limited. Finally,
there is little to suggest a level 5 merging of identities between HP and complementary
medicine. In the UK, merger largely remains a notional category, perhaps best
described as a new paradigm of health care (Hill, 2003b).

Managing collaboration and integration

One problem for collaboration and integration is the lack of a central body with a
responsibility for overseeing the HP/CAM interface. Participants said they needed a
vehicle for an exchange of views across the interface. At present, those wanting to
work with complementary medicine face “re-inventing the wheel” as the work that has
been done so far is difficult to access.
Participants were also unsure as to how integrative work in this area would be
managed. Within the UK, professional leadership is the principal model operating
at the HP/CAM interface. In this model, one professional (or professional group)
leads an inter-professional team (Leathard, 1997). At the HP/CAM interface, the
lead-professional is normally a HP specialist who has involved complementary
therapists in some aspect/s of his/her work. For example, a number of HP lecturers
in the study had employed complementary therapists to offer taster sessions to
HE their students. Health promoters had also employed complementary therapists to
106,4 work with community groups, young mothers and the elderly.
Some participants discussed the possibility of a more egalitarian model where CAM
practitioners would come together with other members of inter-professional teams on
an equal footing. They also discussed the place of CAM within a settings-based
approach to HP. For example, there are examples of CAM included within healthy
286 schools programmes. It was also suggested that health promoters might work as
neutral facilitators helping people choose between different health care systems.
The user-centred model (Leathard, 1997) could be another way to manage
collaboration between HP and complementary medicine. It is already in evidence where
self-help and other user groups determine their own needs. For example, where health
promoters identify needs in partnership with the community and respond with the
provision of complementary therapies as requested. One project in a disadvantaged
area of the UK was providing free complementary therapy sessions in a local
community centre, directly in response to needs expressed by the community. More
often, there is a degree of user-centredness directing health promoters working to the
professional leadership model.

Training for integration and collaboration

Health promoters also find that there is a lack of training in or about complementary
medicine within HP. Those who would like to be more involved with complementary
medicine complain that they lack preparation in this area and that little training is
available to them. Various courses and seminars specifically on complementary
medicine organised for health promoters were described as popular and successful but
HP students called for more in-depth studies in the area.
A particular issue of relevance here is the training of complementary therapists in the
theory and practice of HP. Many health promoters within the study expressed concern
that complementary therapists seemed to be totally unaware of the basic theory and
practice of HP. In particular, concern was voiced that some CAM practitioners use
traditional “victim blaming” techniques that are now largely discredited within HP.
Some health promoters agree with Coward’s (1989) critique of complementary medicine
as elitist and victim blaming. They argue that complementary medicine courses should
include coverage of HP issues and that these issues should be taught by health
promoters. It was also suggested that health promoters might run short courses
specifically for complementary therapists. This would include different approaches to
HP and:
. . . how not to victim blame and how to empower people.
Training clearly links to the issue of training materials and health promoters in this
study were very critical of the current provision. There was a general view that HP
materials largely ignored CAM.

Key determinants of further integration

This section discusses issues from the study that appear to be key determinants of
future developments at the interface. These issues are grouped under five headings: the
changing nature of HP; the changing nature of complementary medicine; the place of
science and biomedicine; the role of the individual; and health, holism and spirituality.
The changing nature of health promotion HP and
There are a number of developments within HP that may be seen as contributing to complementary
increased integration at the HP/CAM interface. The first of these concerns the
changing models of HP and how these relate to the interface. The full range of models medicine
has been discussed elsewhere (Hill, 2003b) but here is particularly relevant to mention
the role of the empowerment model. Empowerment includes working with people on
the issues that they believe to be significant and helping facilitate their own solutions. 287
Adherents to the empowerment model of HP have sometimes found themselves
working with the concerns and interests that their clients have expressed in relation to
complementary medicine. This would include working with ethnic minority
communities that regularly use “traditional” health care systems such as Ayurveda
and Traditional Chinese Medicine in conjunction with biomedical care.
The choice of models is not, however, entirely in the hands of individual health
promoters and it would appear that recent policy initiatives have moved HP firmly in
the direction of the social model. Many health promoters are moving towards a more
public health role and in this study it appeared that those health promoters most
committed to a social model of HP were the least likely to engage with complementary
medicine.
Some aspects of recent government policy may, however, facilitate closer HP/CAM
integration. For example, the emphasis on partnerships and “joined-up” thinking
should encourage HP to think generally in terms of collaborative working. The notion
of “expert patients” in charge of their own care, may foster greater emphasis on
personal choice within healthcare. The introduction of health action zones may lead to
a broader concept of HP within the appropriate setting. However, there have also been
a number of policy initiatives that have served to work against greater integration at
the interface. For example, the introduction of national priority areas and specific
targets has led to health promoters in this study reporting increasing responsibility for
delivering national policy, with less opportunity for local initiative.
Another key feature of national policy has been the push for greater accountability
and the development of an evidence based. Evaluation of effectiveness is now a
significant feature of HP. However, the emphasis on research has presented a major
challenge for HP, which does not lend itself to simple, short-term research methods.
Given the individualistic and subjective nature of much complementary medicine,
proving effectiveness in relation to developments at the HP/CAM interface may
present an even greater challenge than in many other HP areas.
Overall, there are many factors influencing contemporary HP, some supporting
HP/CAM integration and some not. It is possible that the range of policy initiatives is
causing health promoters to become more polarised; some working as public health
specialists, while the remainder maintain a more individualistic/community focus.
The former group concentrate on policy issues and the social model of health and are
unlikely to collaborate or integrate with complementary medicine. However, the latter
group are concerned with individual and community empowerment and may well
increase integration with complementary medicine.

The changing nature of complementary medicine

Part of the increased acceptance of complementary medicine is due to the growth of
research showing the effectiveness of at least some of the therapies involved. While the
HE biomedical community is reluctant to accept much of this evidence, most health
106,4 promoters in the study voiced the view that that there is now a sound evidence base for
at least some of the complementary therapies available. It was argued that the growing
evidence from research advances the general acceptability of complementary medicine
and enables health promoters to fight more effectively for its inclusion in their work.
As one participant said:
288 Having come across a couple of randomised control trials that seem to demonstrate the
effectiveness of at least some complementary medicine, it clearly has to be taken seriously.
While health promoters were mostly convinced of some evidence of effectiveness,
many were far from convinced that all forms of complementary medicine were safe.
Some were concerned about direct risks but more expressed concerns about indirect
risks. For example, many voiced concern in relation to patients failing to seek
biomedical advice because they were seeing complementary therapists.
A related issue for health promoters interested in integration is the patchy quality of
training and registration for complementary therapists. In the study, there was
considerable discussion of “charlatans” and the problems involved in checking the
credibility of individual therapists. Many health promoters and some complementary
therapists voiced concerns about the lack of legal controls over complementary
therapists. However, the study also identified a considerable push for registration
among many complementary therapists. As complementary therapists organise
themselves more along the lines of biomedicine it would appear to be easier for health
promoters to access them and to answer questions of quality control and safety. This, in
turn, increases the possibilities for integration at the interface.
Many complementary therapists argued their work was one and the same as HP
and, in the American context, it was claimed that complementary medicine had taken
over from HP. In the UK context, it was predicted by complementary therapists that
CAM would become more involved in outreach and prevention – working alongside
HP. However, not all complementary therapists were keen on further integration. Some
were concerned about integration because they see it as a force for “watering down” the
nature of complementary medicine. Some therapists object to the push for regulation
and registration, preferring to maintain their individuality and non-conformist nature.
Others are strongly opposed to attempts to research their activities through traditional,
scientific research methods.
Finally, the nature of complementary medicine is still such that many complementary
therapists work in isolation from mainstream healthcare. In particular, some
complementary therapists interviewed for the study were unfamiliar with the concept
of specialist HP. Many complementary therapists, although involved in some form of
HP/education, did not appear to be consciously aware of the professional interface that
exists between themselves and health promoters.

The place of science and biomedicine

Science and biomedicine dominate much of the theory and practice of HP. This has an
important impact on the relationship between HP and complementary medicine.
As argues above, biomedicine is still reluctant to accept many of the claims of
complementary medicine and continues to call for further scientific research into
effectiveness and safety. The research that has been conducted into complementary
medicine is often rejected as inadequate. Health promoters who accept the biomedical HP and
position argue that complementary medicine cannot be incorporated into their practice complementary
until more scientific evidence is available. This creates a rift between some health
promoters and complementary therapists. There is considerable debate at the interface medicine
as to what is to count as research and what level and type of evidence is required.
The following two quotes illustrate the range of opinion:
We are in a catch 22 . . . unless the outcomes of research are appropriate to what alternative
289
medicine is trying to achieve, we will wait for ever. It needs a revolution. We need to focus on
a whole different set of outcomes as measures of effectiveness.

You name me one situation . . . or anybody else name me one situation . . . which does not lend
itself to randomised control trials, and I will pay that person a lot of money.
The concept of “medicine as culture” appears to have influenced many health
promoters. Thus, for example, some participants expressed the view that biomedicine
is not only a science but also a series of cultural practices which health promoters may
wish to question and challenge. Turning to complementary medicine for additional
practices is, they argued, consistent with a new understanding of the role and place of
science and biomedicine. Complementary medicine was said to offer new stories and
rich narratives that people can use to make sense of a changing medical world.
Other health promoters point to increasing links between biomedicine and
complementary medicine as a reason for increased integration. Health promoters
working in a variety of biomedical settings, increasingly find themselves working
alongside complementary therapists. A number of reasons were given for greater
involvement of complementary medicine within biomedicine, including the increasing
problems of long-term, chronic diseases and demographic changes that are challenging
the effectiveness of biomedicine. Some health promoters described a “sea change”
whereby complementary therapists no longer resembled a “loony fringe”.
As complementary therapists become more involved in the world of biomedicine it
is even possible that they might take over some of the roles traditionally ascribed to
HP. Where biomedicine equates complementary medicine and HP with preventative
healthcare there is an argument that goes something like this:
.
Complementary medicine ¼ prevention.
.
HP ¼ prevention.
.
Therefore, complementary medicine ¼ HP.

The study found evidence of this kind of thinking, for example, where NHS doctors
were spending HP budgets on complementary therapies. It was particularly apparent
in the American research, where some HP outreach was entirely composed of
complementary therapies. From a HP perspective, a merged scenario such as this
might appear unwelcome. It could appear to be a displacement of HP, rather than
integration or collaboration. However, biomedical moves in this direction may force
health promoters to work with complementary medicine in order to maintain their role
within preventative healthcare. Alternatively, in order to maintain their autonomy,
health promoters might resist moves to integrate complementary medicine within
biomedicine.
HE The role of the individual and personal experience
106,4 . . . complementary medicine often depends on a key person placed . . .
Several participants reported that involvement of complementary medicine within HP is
often due solely to the interest of one individual. On the HP side, these individuals
include many of those who are committed to a more holistic approach to health and who
290 reject medical model HP practice. Some HP participants in this study were personally
committed to complementary medicine and wanted to extend their interests into their
professional roles. In the majority of cases this commitment was explained as stemming
from positive experience of complementary medicine in their personal lives. Participants
admitted promoting the therapies that they personally felt comfortable with:
You promote your own particular view of the world. And you promote your own particular
view of complementary therapies.
I was told that many of those health promoters who are ready to accept the evidence
available for complementary medicine find their hands tied by biomedical colleagues.
There is a sense in which health promoters wishing to include complementary
medicine are doing so “by the back door”. They are finding ways of subverting the
dominance of biomedicine within society but often at some personal/professional risk
to themselves.
It should also be acknowledged that, in a very few cases, health promoters reported
negative experiences of complementary medicine which they described as leaving
them personally opposed to professional developments at the interface.
Individual therapists and other individuals involved in complementary medicine
should also be mentioned. Often pioneers in their own field, many of the complementary
therapists appeared keen to reach out to HP and to “share the message” of the work they
were engaged in. Many had been employed within biomedicine or traditional research
before moving into complementary medicine and were keen to break down barriers
between the two areas. In the interviews, they sometimes portrayed an almost
missionary zeal in their desire to share their perceptions of health and healthcare with
conventional health promoters.
If we consider integration at the HP/CM interface to be an innovation, it may be
useful to consider innovation-diffusion theory (Rogers and Shoemaker, 1971). The
health promoters and complementary therapists keen on integration may be seen as
innovators and early adopters for greater integration at the HP/CM interface. As the
interface is a professional interface, these innovators/early adopters may also be
described as “change agents”. Innovation-diffusion theory usually places change
agents outside the group to be changed, but here there is no relevant outside agency
and the role adopted by some of the innovators/early adopters fits that of a change
agent. In particular, these health promoters/complementary therapists take on the role
of mediating across the interface in a similar way to a professional change agent
mediating between client and agency.

Health, holism and spirituality

Changes in social concepts of health were seen by many participants as contributing
towards a more open approach to complementary medicine. Most health promoters
and complementary therapists shared a commitment to a salutogenic view of health
and well-being. Indeed, complementary therapists tended to contrast their work with HP and
medical-model practice, which they saw largely as illness based. Health promoters complementary
keen on promoting positive well-being appeared interested in working with
complementary medicine. medicine
It might also be assumed that health promoters and complementary therapists are
similarly united in their commitment to holism. Complementary therapists usually claim
to work holistically and many health promoters see collaboration with complementary 291
medicine as one way to make their own practice more holistic. Health promoters and
complementary therapists share an understanding of holism that involves working with
the whole person – physical, emotional, mental, psychosocial and spiritual. However, a
number of the other characteristics of holism identified by complementary therapists
would not lend themselves so readily to HP. Most importantly, the CAM view of holism
includes the belief that clients are actively involved in creating the reality of their
conditions, and are capable of changing their conditions. This is unacceptable to may
health promoters. As discussed above, many health promoters are concerned at the
victim blaming potential of complementary medicine. Different interpretations of
personal responsibility in relation to health status present potential barriers to HP/CAM
integration.
Complementary medicine also works with the concepts of energy and balance;
concepts that are closely linked in the literature with holism and positive health. The
basic idea assumes an energy field in and around the body. Many complementary
therapies work from the premise that this energy field can be manipulated to improve
health and that maximising health involves balancing and harmonising the energies of
the bodies. These energy theories proved difficult for many health promoters. Some
were concerned that the ideas involved were too “way out” and others that they might
cause offence to religious communities.
Another key factor here is the issue of spirituality. An holistic approach is often
assumed to involve spirituality but much contemporary HP has ignored the spiritual
dimension. (Hill and Stears, 1995). Few health promoters in the study claimed to
include issues of spirituality in their work. Many endorsed issues of spirituality in
theory but admitted paying lip service to the concept while taking no real action.
However, spirituality is often seen as integral to the philosophy and practice of
complementary medicine. Many heath promoters argued that collaboration with
complementary medicine would be one way for HP to actively address the spiritual
dimension of health.
Many of the complementary therapists interviewed argued passionately for
inclusion of the spiritual dimension. Spirituality was described as an important part of
many complementary therapies. One complementary therapist asserted:
. . .we have to go beyond the scientific realm in how we treat people . . . and we have to take
into account the spiritual . . . And if you do not deal with the spiritual . . . then you are still
missing the boat . . . That’s the S word . . . The spirit is not given it is proper place.
The spiritual dimension was clearly important to most complementary therapists in
this study. However, while many health promoters also expressed the importance of
spirituality, on closer examination there may be significance differences. First, health
promoters did not appear to give spirituality the central position claimed by many
complementary therapists. Some rejected the term spirituality in favour of less
HE religious concepts such as “meaning and purpose”. Some health promoters were
106,4 concerned that working in the area of spirituality would be unacceptable to their
clients. The situation is, therefore, quite complex. On the one hand, many health
promoters are attracted to complementary medicine because it includes a spiritual
dimension. However, they may be unwilling or unable to work with the concepts of
spirituality employed by some complementary therapists.
292
Conclusion
This paper used the calibration model as a tool to analyse the extent of collaboration
and/or integration evident at The HP/CAM interface. It was argued that the current
HP/CAM interface mostly exists as two separate entities with limited integration or
collaboration. However, this appears to be changing and there are many examples of
low level collaboration through the provision of shared information. There are also
examples of health promoters organising complementary therapies for their clients and
some examples of partnership working. Merged identities appeared to be limited to
examples from the USA.
Having considered the current levels of collaboration and/or integration, the paper
examined possible ways in which the interface might be managed and the training that
would be necessary if integration was to evolve. It was noted that there is little national
leadership in this area and that many health promoters involved in complementary
medicine feel isolated. Where integration is occurring, it is usually dependent on key
individuals working to the professional leadership model. There is a need for further
training to be developed. Professionals on either side of the interface requested more
training to ensure adequate understanding of both HP and CAM.
The paper discussed a number of factors that will determine how far the interface
moves towards further integration. These determinants include: the changing nature of
both HP and complementary medicine; the place of science and biomedicine; the role of
the individual; and changing perceptions of health, holism and spirituality. Running
through the discussion was an attempt to predict future developments at the interface.
More research is, of course, needed to determine this with any certainty. However, it
seems highly likely that where health promoters are interested in individual health
gain they may work increasingly closely with complementary medicine. Health
promoters with a predominantly public health role are unlikely to increase
collaboration with complementary medicine in the foreseeable future.

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