Cultivating Equity in Integrative Medicine

On the final day of the 2023 Academy of Integrative Health and Medicine (AIHM) Annual Conference in San Diego, Calif., members of the AIHM Black, Indigenous, and People of Color (BIPOC) Committee discussed what health equity looks like in an integrative medicine practice. In their presentation, the committee members stressed the importance of cultural appreciation, spiritual presence, cultural humility, and embodiment to move integrative medicine toward health equity.

“The BIPOC Committee has an understanding that all of the work that we do, we feel it in our bodies,” said Yvette Miller, MD, ABIHM, Executive Medical Officer for the Donor and Client Support Center (DCSC) in Charlotte, NC, and Co-Chair of BIPOC Committee. In this country, medical providers are encouraged to get out of their bodies and think their way through treating a patient, but, Miller said, “true medicine and healing comes from the heart and the body.”

The AIHM BIPOC Committee's mission is to provide practitioners with the knowledge and tools to practice integrative medicine through a lens of health equity. The committee’s other Co-Chair, Jean Davis, PhD, PA, said the committee defines an equity lens as a way of understanding and structuring personal and collective action that is grounded on:

1. Recognition of the systemic practice and consequences of the differential valuation of people across the seeming differences and how these lead to gaps in the ability of specific groups to live and thrive.
2. Commitment to creating the conditions that allow all people to flourish.

Unlike equality, which assumes everyone needs the same thing, equity acknowledges the disadvantages some people and groups face and provides support accordingly, explained Davis, Associate Professor of Internal Medicine at Charles Drew University of Medicine and Science in Los Angeles. “We need to meet patients where they are.”

Davis went on to say that equity-deserving communities are not limited to race, ethnicity, sexual orientation, or gender. “Oftentimes people don’t deal with equity because they think it’s only talking about ‘those people,’” said Davis. “It is not about ‘those people’; it’s about each and every one of us”.

To practice medicine through a lens of equity, providers must acknowledge the deep-seated discrimination within the healthcare system and the history behind it, according to Grace Alvarez Sesma, cultural practitioner (curandera) of Mexican traditional healing and BIPOC Committee member. And to do this, she said, we must address the lasting impacts of colonization on indigenous communities.

“Confronting painful truths requires that we all take an honest look at how the healthcare system continues today to benefit from colonialism,” said Sesma, “including outcomes of experimentation on indigenous peoples and persons of color, medical bias, and the cycle of poverty that gives rise to illness and illness to poverty.”

It’s also important to recognize the cultural appropriation that takes place in integrative medicine, explained Sesma. Cultural appropriation results from colonization of global indigenous practices. Sesma detailed many mind-body practices appropriated and commodified within integrative medicine, including yoga, the use of ceremonial plants, mushroom medicines, and devotional mantras.

“Persons who have appropriated culture do not ask for permission from the community where they take it from,” said Sesma. “They do not undertake traditional training, and there is no long-term reciprocal relationship with the elders or indigenous communities where they claim to get their information nor is there attribution or compensation to those from whom they've stolen indigenous traditional knowledge.”

When indigenous mind-body practices are appropriated and commodified, seen in the form of mindfulness classes, spiritual retreats, and conferences, they are often inaccessible and exclusionary to the communities in which they originated.  

“There's a lack of cultural experts and diversity among teachers, presenters, and participants. This can be due to high registration fees, which are not affordable to many of us community cultural healers, or deliberate exclusion,” Sema said. “These and other actions are a form of modern-day colonization and oppression that continues to harm our Black, indigenous, and people of color communities.”

One way to address cultural appropriation is through cultural humility, an ongoing process of self-reflection and self-critique about one's own cultural biases, according to Rashmi Muller, MD, integrative endocrinologist and member of the BIPOC Committee. Cultural humility requires practitioners to acknowledge their limitations and be open to learning and correcting their mistakes.

To avoid cultural appropriation, Muller said it’s important that practitioners check in with themselves, asking questions like:

• Who is adopting this practice?
• What is the history behind the adopted practice?
• Why is this practice being adopted, and does it honor the origins of the appropriated culture?

After asking these questions, it’s crucial that practitioners expand the discussion with a diverse and inclusive group to gain perspective for cultural humility, Muller added.

Despite a practitioner’s cultural appreciation for mind-body practices, it's important to note that integrative modalities aren't always practical for patients, especially those suffering from grief and trauma, Muller explained. Before suggesting that patients try contemplative practice, practitioners must sit with them in their grief, she said.

To be present with patients and provide them with the space to grieve requires practitioners first to resolve their own issues, Miller, the Committee Co-Chair, added. Otherwise, she said, patient experiences could trigger their own problems, take themselves out of the moment, and lose focus on the patient's needs. This can lead to spiritual bypassing, defined as using spirituality to avoid facing unresolved personal, interpersonal, or systemic issues. In integrative medicine, it can unintentionally negate a patient's genuine experiences.

"We know that taking someone through a mind-body practice can help them feel better, but if we're not able to get to the root cause of why they're struggling and suffering and show them true compassion by sitting with their pain, all we're doing is contributing to bypassing and dismissing the person's lived experience,” Muller said. 

To practice cultural appreciation and spiritual presence, Muller suggested that providers,

• Be present, ask questions, and listen.
• Ask patients if they have a spiritual affiliation.
• Find out how to partner with cultural practitioners in your integrative practice/team.
• Know what community resources are available.
• Foster respectful, anti-colonial relationships with Cultural Practitioners and Traditional Healers.

“We all understand and recognize the importance of this transition to a whole health movement in this country, but it's important for us to recognize that this idea of the mind-body-spirit connection to support health is not new. It's not new to whole health. It's not new to the holistic health movement. It's not new to modern medicine. These are these are ancient and global cultural traditions,” said Muller. “We can't just cherry-pick what we want; we really need to be authentic.”

Editor's note: This article is part of our live coverage of the 2023 Academy of Integrative Health and Medicine Conference. Click here for a list of full coverage.