Incorporating Complementary and Integrative Health Providers in the Public Health Pandemic Response: Lessons from COVID-19 and Recommendations for the Future from a Multidisciplinary Expert Panel

Background

During peak periods of the coronavirus disease 2019 (COVID-19) pandemic, many complementary and integrative health (CIH) providers, such as chiropractors and naturopathic doctors, saw their clinical practice reduced substantially or shut down completely. Simultaneously, many public health and medical practitioners were overwhelmed with providing emergency care and implementing mass testing and other preventive measures. CIH providers have been an underutilized public health asset in the fight against COVID-19. Researchers with the RAND Center for Collaborative Research in Complementary and Integrative Health sought to understand how these providers can be effectively integrated into future responses to public health emergencies.

Methods

The RAND team convened an expert panel of ten CIH and public health practitioners and researchers. We provided the panelists a review of the news media and the scientific literature about the essential tasks facing the public health workforce during a pandemic, how CIH practitioners could contribute, and how the CIH workforce could be better mobilized during future crises. RAND facilitated a daylong online panel discussion about these topics. The expert panel conversations were transcribed, and we identified key themes and recommendations.

Results

Essential tasks in the early response to the COVID-19 pandemic included testing, contact tracing, and education about prevention. Despite their clinical skills and resources, few CIH providers were involved in this work. We reviewed some exemplar cases where CIH providers were highly involved in the public health response.

Panelists stated that the reason CIH providers generally did not pivot toward public health activities was not their lack of specific skills to do needed tasks. Rather, panelists noted a lack of public health awareness among CIH providers, insufficient linkages between CIH and public health professionals, and policy and financial challenges facing CIH professionals during the pandemic. Panelists proposed solutions to these barriers, including more public health training for CIH students and practitioners, stronger formal relationships between CIH and public health organizations, and addressing fundamental funding issues.

Discussion

The literature review and panel discussion revealed that, in order for CIH practitioners to be more fully involved in responding to future public health crises, some changes to their training and interprofessional linkages are necessary. Specifically, there is a need for (1) mutual awareness—a recognition among CIH providers that they can fulfill a key role in a public health response, and recognition among public health planners of this potential; (2) training—increasing education opportunities in public health for CIH providers; (3) connections—building stronger links between CIH and public health professional organizations; (4) financial support for CIH providers contending with underlying economic challenges; and (5) formalizing public health within CIH—advancing public health within the scope of practice of the CIH professions, including by statute.

More broadly, those involved in public health planning should recognize CIH providers as an existing and organized labor resource that can be called upon in a public health crisis. They possess both the clinical expertise and the community-level connections to complement the public health workforce. In addition, CIH professionals should be more proactive in seeking out a role and volunteering their knowledge, skills, and expertise.