Cover: Incorporating Complementary and Integrative Health Providers in the Public Health Pandemic Response

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

Published Feb 17, 2022

by Ian D. Coulter, Margaret D. Whitley, Raheleh Khorsan, Patricia M. Herman

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Research Questions

  1. What public health role can CIH professions play in a pandemic, over and above the treatment of individual patients?
  2. What barriers exist to CIH professions mobilizing collectively in a pandemic or other public health crisis to form part of the public health intervention at a population and community level?

Complementary and integrative health (CIH) providers, such as chiropractors and naturopathic doctors, have been an underutilized public health asset in the response to the COVID-19 pandemic. This report seeks to inform how they can be better integrated into future responses to public health emergencies.

The authors convened an expert panel of ten CIH and public health practitioners and researchers for a daylong discussion of how the CIH workforce could be better mobilized during future crises. In this report, the authors summarize the key barriers identified in the discussion and make recommendations on how they can be overcome.

Key Findings

  • Key barriers to CIH providers' involvement in public health responses involve attitudes and awareness rather than a lack of specific skills.
  • Education of CIH providers often does not strongly emphasize public health.
  • There is a disconnect between CIH and public health; CIH focuses on the health of the individual, whereas public health focuses on the health of the community. Furthermore, there are few settings where CIH and public health professionals are colocated.
  • CIH providers have faced economic challenges both before and during the pandemic, which may have been a barrier to many of them becoming involved in public health efforts.
  • Attitudes about vaccination can be a barrier—not just vaccine hesitancy among some CIH providers, but also a perception by public health professionals that vaccine hesitancy among CIH professionals is widespread.
  • Most CIH professionals practice in isolated practices and not in teams, whereas public health is overwhelmingly practiced as a team effort.


  • CIH providers should recognize that their contributions to public health efforts could be important and welcome, and public health planners should recognize CIH providers as a resource that can be utilized.
  • The training of CIH providers should include content to ensure their proficiency in topics such as basic epidemiology and community-based interventions. More MPH degrees would be helpful, but, in the short term, short intensives—especially online—could begin to fill the gap and would include training for established practitioners.
  • Stronger linkages between CIH and public health practitioners, leaders, and professional organizations are needed to facilitate the mobilization of CIH providers in an emergency. In the short term, promotion of more presentations in the two CIH-related sections of the American Public Health Association and sessions focused on the connection between public health planners and CIH practitioners would help. Public health officials should also be invited to speak at CIH conferences.
  • Continued advocacy about the importance of CIH care, including recognition that it is essential health care and support for insurance coverage of CIH services, is important to give CIH providers sufficient financial stability to allow them to engage in responses to public health crises.
  • Making public health service more economically viable would also draw more CIH providers to this field.
  • Efforts to better incorporate CIH providers in public health efforts need to acknowledge and directly address issues on which public health professionals and some CIH providers may not completely align, in particular regarding vaccinations and team participation.

Research conducted by

This research was jointly funded by the National Chiropractic Mutual Insurance Company (NCMIC) Foundation and by donations from the institutional members of the RAND Center for Collaborative Research in Complementary and Integrative Health. The research was conducted by RAND Health Care.

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